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theconcernedone

Medical fraud in Turkish hospitals?

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My SGK-insured father recently agreed to undergo surgery to correct a problem he had with his vertebrae in Alanya at the private Baskent hospital. The total price for the surgery was less than 3000TL and was paid before the operation. However, something happened during the surgery that supposedly necessitated the installation of two titanium screws at extra cost of around 10000TL.What do you think are the chances that there's some sort of fraud involved instead of a genuine need to save my father's well-being? Just thinking quick it certainly occurred to me that the surgeon may have anticipated such a need before the operation but neglected to inform my father of this as he would not have agreed to such an expensive operation. Of course there are many other possibilities like the lack of any actual need for such costly extras.Do you have any suggestions how one could proceed in this sort of a situation?

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Probably the only organization which would carry out an investigation on this would be the SGK. Of course there is fraud in the system, there is fraud in every healthcare system, and the organizations who pay for medical procedures would want to know if an operation was unnecessary. The doctor might have a record of providing unnecessary procedures which might cause them to look in to this one, but only the SGK would know that. So you would need to find out what branch of the SGK carries out these investigations and speak with them. I investigated healthcare fraud in the US before, so I am only going on my knowledge from that.

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Thanks for the reply. I can only hope someone at the SGK will investigate the matter after they have been properly informed of the situation.

Anyway, you don't think there's anything the police would do in this case? Obviously they would need to have some independent medical experts to review the situation and I can understand it might be difficult to get that sort of effort from them. Though if they have received any previous complaints of possible criminal behavior at the same hospital who knows they just might do it. Now I'm a hopeless optimist...

I guess the situation could be worse as my father is still breathing and is starting to feel better. I understand he did get some bacterial infection during the surgery as well but at least the antibiotics did their trick.

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Posted Image Honestly speaking, I am not satisfied with Turkey's health care system. You might be charged more because you are not Turkish.

Last time my friend got diarrhea. He went to a hospital. The doctor asked our translator "whether this Chinese is rich". Later he asked for 3000 TL. Posted Image

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Anyway, you don't think there's anything the police would do in this case? Obviously they would need to have some independent medical experts to review the situation and I can understand it might be difficult to get that sort of effort from them. Though if they have received any previous complaints of possible criminal behavior at the same hospital who knows they just might do it. Now I'm a hopeless optimist...

The Turkish National Police does have a fraud unit, but that's all I know, unfortunately. You could find out which unit might investigate medical fraud from the TNP or from the SGK. I'm thinking that the SGK would be more helpful, at least from a billing standpoint. As far as the necessity of the procedure, there might be other doctors who say that the procedure was unnecessary, but it doesn't mean that their opinion will be better than the doctor who operated, since they weren't there when the operation occurred. My cases in the past were successful because others who were present provided testimony against those who falsely billed for the services, for example, the doctor billing when he wasn't even there, or for procedures the patient never received. What you would be asking is a case based on a second guess of a doctor's actions, which occurred during an event only he and a few perhaps unqualified others witnessed. Also you should consider that the procedure may have been necessary and that the doctor did the right thing under the circumstances.

I'm definitely not saying that you should let it go, I'm just giving you an opinion from my own experience and suggesting where to go to pursue this further. I'd really like to hear about how this turns out.

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My SGK-insured father recently agreed to undergo surgery to correct a problem he had with his vertebrae in Alanya at the private Baskent hospital. The total price for the surgery was less than 3000TL and was paid before the operation. However, something happened during the surgery that supposedly necessitated the installation of two titanium screws at extra cost of around 10000TL.

Of course, it costs much more because you went to a private hospital. Why didn't you go to a public hospital? You know SGK is about public hospitals, not private ones.

Honestly speaking, I am not satisfied with Turkey's health care system. You might be charged more because you are not Turkish.

Last time my friend got diarrhea. He went to a hospital. The doctor asked our translator "whether this Chinese is rich". Later he asked for 3000 TL.

Turkish healthcare system is much more better than rest of Europe. Just try to go to a hospital in the UK. They won't accept you and they will let you die.

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To his credit at least the surgeon had the appearance of respectability when I briefly met him. One just gets naturally suspicous of such unexpected extra charges in a place where bilking foreigners is something akin to a national sport. I'm of course a total layman myself so I can't speak with any knowledge but it just seems rather unbelievable that a reasonably experienced professional could not see that sort of a thing coming before the operation.

Anyway, we did actually manage to get my father out of the hospital without paying the extra bill which I understand is a little unusual in Turkey...

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Of course, it costs much more because you went to a private hospital. Why didn't you go to a public hospital? You know SGK is about public hospitals, not private ones.

Turkish healthcare system is much more better than rest of Europe. Just try to go to a hospital in the UK. They won't accept you and they will let you die.

This is true. It's a major thing in the UK at the moment, we're actually encouraging people with minor complaints to go to hospitals in the UK so they can die. Last week David Cameron was in Switzerland to meet with the head of Dignitas, they struck a deal and now all UK hospitals will let you walk in and just die. Although it costs if you die in reception.

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I can understand your concern but to say anything about what was or became necessary during surgery is absolutely not possible. Operations on the vertebrates are nearly always very complex and to be honest I`m surprised that you were only quoted such a low price.

Your explanation that it was an operation "to correct a problem with his vertebrae" is very vague, sorry. What does it mean? he had back pain, problems walking, was the spinal column involved, slipped or unstable disc? the list is endless and there is no way of knowing what was necessary without knowing the medical background.

Did your father not have to sign documents before the operation that should explain that things can happen during the op? they are the papers the hospital needs to cover itself against claims.

He should have a copy of these.

The only way I can see to find out if there was something fishy going on is to take these papers and go to a different doctor who then could ask for the medical reports and look into it for you.

And Turko, really???? I don`t know where you get your uneducated information from or if you just have fun sprouting rubbish :)

This is true. It's a major thing in the UK at the moment, we're actually encouraging people with minor complaints to go to hospitals in the UK so they can die. Last week David Cameron was in Switzerland to meet with the head of Dignitas, they struck a deal and now all UK hospitals will let you walk in and just die. Although it costs if you die in reception.

That just made my day Clinky Posted Image

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Many private Turkish hospitals accept SGK on a co-pay basis.

You have to find out in advance if the hospital and the doctor will do this. Last year my wife had to consult a cardiologist, we saw him with a one-day notice after a phone call from our local doctor. (That would be impossible in the USA) We went to the cardiologists office he ran some tests, took some blood and a sonogram and asked her to stay overnight in the hospital. I was able to stay with her in a private room with a small couch. The hospital staff fed both of us and treated us like we were in a hotel--and the food was good! Posted Image All was very clean and modern. After some more tests the next morning and a prescription, we went to the office to settle our bill. Our total out of pocket cost was 175 TL!! Posted Image The clerk said the cost of everything including the cardiologist consultation and treatment was several thousand Turkish Lira. I was stunned to say the least. We drove from Kaş to Antalya for that and back so our gasoline cost us more than that!!!

I am firmly convinced that the Turkish health system is far better than that of the United States unless you have very expensive private health insurance or your employer insures you. There are over 40 million people in the USA without health insurance. Posted Image If you are below the poverty line in Turkey, you can apply for a card which still allows you to be covered at no cost.

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I can understand your concern but to say anything about what was or became necessary during surgery is absolutely not possible. Operations on the vertebrates are nearly always very complex and to be honest I`m surprised that you were only quoted such a low price.

Yes, I would think so as well. However, the surgeon was very definitive about the price so that doesn't excuse him. The problem was identified using magnetic imaging so the estimate was not based on nothing. I do have those images with me so I can show them to other neurosurgeons when necessary to get their opinion if it would have been reasonable to expect any need for those expensive titanium nails. Obviously though if such operations are commonly very risky the surgeon should not have given such a low figure.

I'm not denying my father acted without careful consideration as he was in a hurry to "end the pain". I did myself recommend to him that he should fly back to his home country to get the necessary treatment.

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Its always difficult to make decisions when you are in pain :( did your father get the quote in writing?

also, in most cases you don`t see just 2 titanium screws but rods or plates

and you want to show the images to a orthopedic surgeon not neurosurgeon :)

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If those titanium screws are anything like the ones they use for dental implants (but perhaps even larger), then I guess they would be expensive, but 10,000TL still seems a bit pricey ?). The issue is really that they were unexpectedly fitted without the patient's prior knowledge, and that seem a bit underhanded to me.

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When I first saw the title of this topic, I thought I would see a link to an article by a journalist or researcher into widespread abuses of the Turkish health system. Instead, we hear of one allegation, against one doctor.

theconcernedone writes "Do you have any suggestions how one could proceed in this sort of a situation?"

Ken and other forum members have given you very good advice, it would good for you to follow through on the very helpful suggestions given.

theconcernedone writes "I can only hope someone at the SGK will investigate the matter after they have been properly informed of the situation...Anyway, you don't think there's anything the police would do in this case?"

I can think of no instance short of a witnessed and documented murder or some other outlandish and obvious crime where the police would move in on a doctor in such a circumstance without an order from a prosecutor. Perhaps Ken can enlighten us further about this...

First you will need to show proof of fraud. You are making the accusation Have you spoken with the doctor who performed the surgery? Since your father was released without paying for the extra items on the bill, you can go back to the surgeon and try to find out why he felt the extra procedure and cost was necessary and ask why the hospital released him even though the bill was not paid in full. Have the surgeon give you copies of any papers related to the surgery and ask for an explanation in writing. Have you spoken with the hospital administration?

Until you confront the doctor and the administration, you have not "exhausted your administrative remedies" and therefore do not have any reason to complain to any other organisation.

IF, after you speak to the surgeon and the hospital, and you still do not believe the procedure was justified, you could send the doctor AND the hospital a letter stating your grievance and ask for a written response. In the meantime you can attempt to get a second opinon from another surgeon or two. From the few cases I knew of in the United States, surgeons are a small community and they are extremely reluctant to say anything negative about a colleague, especially in a case like this one where the patient came out feeling better. Perhaps you will get lucky and find a second opinion in your favor.

IF you find second opinions which agree with you, then you might be able to take your case to the SGK. If you make a formal, written complaint, in Turkish, to SGK, they would probably be required by law to investigate an allegation of fraud or malpractice.

AFTER, the SGK investigates and IF it gives you a report in your favor, they may follow through with sanctions, or they may give the surgeon a warning, or they may do nothing further, no one can know at this stage of the events.

IF SGK does not follow through to your satisfaction, you will probably need to take your evidence to an attorney who specialises in malpractice cases. Then your attorney would probably confront the doctor and the hospital for a possible settlement. If none could be agreed upon you would then need to take your case to a prosecutor and see if their office determines that fraud has taken place.

theconcernedone writes "One just gets naturally suspicous of such unexpected extra charges in a place where bilking foreigners is something akin to a national sport."
A rather strong allegation methinks... Perhaps you could document this "national sport" of which you speak? Do you have any research or documents which would tell us that this has become a nation-wide phenomenon?

I have been here 13 years and NEVER felt I was "bilked." I have been in several medical situations both in clinics and have been admitted to the hospital and I always felt I was getting health care equal to or even better than when I was in the United States. I was treated at a state (public) hospital and was treated with courtesy and respect for my illness.

I have had personal experience of doctors making a house call, several times, for an ailment of mine, unheard of in the United States...

Doctors in Turkey give out cards with their mobile phone numbers on them, unheard of in the United States...

Of course I have no experience nor knowledge of the health care system in Finland, probably your father should have listened to your suggestion that he return to his country, then you could have taken on any problems with a doctor there in your home country.

Posted Image Honestly speaking, I am not satisfied with Turkey's health care system. You might be charged more because you are not Turkish. Last time my friend got diarrhea. He went to a hospital. The doctor asked our translator "whether this Chinese is rich". Later he asked for 3000 TL. Posted Image

conan, is this the only instance of your dissatisfaction with the Turkish health care system? If so, it seems a slight foundation upon which to build such a comment. Please give us the details about why your friend was given what you believe was a large bill. Also please state all the other examples of where you were mistreated, misguided or misused within the health system. Did you use your translator to make formal complaint to the doctors, hospital administrators or SGK?

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When I first saw the title of this topic, I thought I would see a link to an article by a journalist or researcher into widespread abuses of the Turkish health system. Instead, we hear of one allegation, against one doctor.

theconcernedone writes "Do you have any suggestions how one could proceed in this sort of a situation?"Ken and other forum members have given you very good advice, it would good for you to follow through on the very helpful suggestions given.

Yes, thanks everyone! I will try to do my best to get the matter solved though it seems likely it will take some time. We still haven't received the surgeon's full explanation of why he needed to do what he did and why he could not predict the need for those nails before the operation and I have some holes in my knowledge of the situation such as I don't yet know for certain whether my father signed any documents acknowledging that he is aware of the financial risks involved before the operation (he was in a confused state and obviously had a language barrier to deal with).

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I did finally get my hands on the translated report of the surgery provided by the Baskent hospital. What may be noteworthy is that it does not mention that anything unexpected happened during the operation, it just notes that what was agreed to be done was done and that there were no complications after the surgery. So obviously it is not helpful at all in understanding the justfication for the extra 10000TL charge.

I wonder if this is common around the world or just in Turkey. Maybe it's just me but I'd definitely like to see a little bit more accountability...

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Playing devil's advocate here - what if the surgeon had not put the nails or screws in and had sewed him back up and given your father the justification that the necessary work had not been done because it was over the agreed budget?

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Playing devil's advocate here - what if the surgeon had not put the nails or screws in and had sewed him back up and given your father the justification that the necessary work had not been done because it was over the agreed budget?

It would be a safe bet my father would not have been particularly pleased, but then again, he would be free to get the needed care elsewhere with some added knowledge.

Also, he would not have to worry about ending up in a Turkish prison due to hospital debt Posted Image

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I have some holes in my knowledge of the situation such as I don't yet know for certain whether my father signed any documents acknowledging that he is aware of the financial risks involved before the operation (he was in

a confused state and obviously had a language barrier to deal with).

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Has someone informed you that prison is in the works for not paying a bill? Does Turkey have a debtor's prison? Have you asked an attorney about this? Your father is not a Turkish citizen, not being able to pay or slow paying or declaring insufficient funds to pay, would seemingly not be prison offenses. I would like to see a copy of the law regarding that issue. Can any of the TC lawyers help us out here please?

I have never failed to get a full accounting for any services I have asked for whether they be an automobile repair, or health care, or just grocery shopping. Just plain common sense to ask for a full accounting BEFORE you leave a place that is asking for your money. Medical fraud, IF indeed any has been committed here and as yet you have not shown any proof of that, is not unique in Turkey and in fact is far surpassed in many of the so-called Western nations, the USA being at the top of the list. Even conservatives are crying that the cost of medical care has gotten out of control because doctors and pharmaceutical companies gouge their customers/clients/patients and there seems to be no way to stop it.

Why, I wonder, do you cast these negative comments on Turkey? Debtor's prison, alleged medical fraud, saying that Turkey is a country where "bilking foreigners is something akin to a national sport."

Yes, I have heard that there are several foreigners in a nearby prison in Mahmutlar because they have not paid their debts. I can not however personally guarantee the veracity of that hearsay. You can read about the law online. Of course we are doing our best to ensure my father won't be going to prison for this hospital debt.

And just to be clear, I have nowhere claimed to have any proof of actual wrongdoing on the hospital's part. I simply started this thread to get ideas on how to go about investigating the issue.

I'm obviously not from the states myself but I have read about the situation there. There's of course this one particular ethnic group that is highly overrepresented among the medical professionals which may have something to do with the prevalence of fraud in the system but if I get any more specific I can easily get banned from the forums.

before any operation there is a lot of paperwork to fill out, I can`t imagine that this is any different in Turkey. Have you seen your fathers papers yet? you say :

" it just notes that what was agreed to be done was done " so the question is what was agreed??? where is the agreement?

If there is a discrepancy between your fathers agreement and the translated surgery report then you have a case, if not then not, simples Posted Image

To the best of my knowledge my father did not really sign the sort of paperwork one would expect. The agreement was oral. As I noted in my previous post the surgery report did not mention anything about "titanium nails" or anything else to justify the significant extra charge. So one would think the low initial price would still be all what the hospital demands but they claim otherwise. I can't help if you don't see anything fishy in that.

And sorry, I did not realize that one is expected to view Turkey through rose-colored glasses on this forum. However, you are probably aware that during this "Turkish Summer" even quite a few Turks have been getting fed up with the system.

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There's of course this one particular ethnic group that is highly overrepresented among the medical professionals which may have something to do with the prevalence of fraud in the system but if I get any more specific I can easily get banned from the forums.

With that sort of racist comment, I am not surprised you are banned from forums.

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I do not expect anyone to view Turkey through "rose-colored glasses," living here does have its difficulties for foreigners and Turkish people alike. Rather it is a useful service when a member makes available to the forum, any data backing up negative or positive allegations, as an example, the article about prison for debts is just such data, thank you. Posted Image

Do you have similar data for the allegation that Turkey is a country where "bilking foreigners is something akin to a national sport."?

Being fed up with a system of government and casting negative comments onto a broader segment of the members of Turkish society are two different things. Comments about "ethnic groups" in the States for example... Posted Image

"And just to be clear, I have nowhere claimed to have any proof of actual wrongdoing on the hospital's part."

The title of the post clearly states "Medical Fraud in Turkish hospitals," which, as I read it, is a form of wrongdoing or fraud since the only hospital you mention is the one with which your father is having difficulty.

Good luck to you and your father. Let us hope your situation is resolved to everyone's satisfaction.

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There's of course this one particular ethnic group that is highly overrepresented among the medical professionals which may have something to do with the prevalence of fraud in the system but if I get any more specific I can easily get banned from the forums.

Would you please back up that statement with official figures to prove that claim.

And sorry, I did not realize that one is expected to view Turkey through rose-colored glasses on this forum. However, you are probably aware that during this "Turkish Summer" even quite a few Turks have been getting fed up with the system.

If you had taken the time to read through the forum threads you will see we aren't actually wearing rose-coloured glasses.

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