Clinic head jailed for 5 years over $160,000 medical insurance fraud
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The head of a private clinic in Astana was sentenced to five years in prison for defrauding the Social Health Insurance Fund of 79 million tenge ($160,000). The scheme involved falsifying patient registrations and medical service records in the Damumed system, with the help of a healthcare center employee who approved fake applications.
The Fraud Scheme
The head of Forte Clinic (Tumar) orchestrated a scheme to artificially inflate the number of patients registered with the clinic to receive unwarranted funding from the Social Health Insurance Fund (FSMS), according to the Agency for Financial Monitoring (AFM). A staff member of the National Scientific Center for Health Development used his official access to approve fake registration applications. Over 15,000 people were falsely registered, including residents of other regions, minors without legal guardians' documents, and individuals who had left Kazakhstan.
Damumed System Abuse
The clinic director gained control over medical workers' accounts in the Damumed information system by linking them to administrative phone numbers. Using this access, he entered fictitious records of medical services supposedly provided to illegally registered patients, creating grounds for funding from the FSMS. The total damage to the state amounted to 79 million tenge ($160,000).
Sentences and Reparations
The court sentenced the clinic director to five years in prison and the healthcare center employee to three years. The full amount of damages was repaid. The verdict has entered into force. Earlier, a similar scheme was uncovered in the Mangystau region, where men were recorded as receiving gynecological procedures.
What's Next
The AFM is expected to continue audits of medical organizations to detect similar fraud schemes. It remains unclear whether further prosecutions will follow or if systemic reforms to the Damumed system will be implemented.
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Clinic head jailed for 5 years over $160,000 medical insurance fraud
