Pension Fund Gains Authority to Recover Funds from Doctors Over Sick Leave

Revised Oversight for Medical Certificates

According to ХВИЛЯ: Starting April 1, Ukraine is implementing new rules for monitoring the issuance of sick leave certificates. These amendments to the law 'On Mandatory State Social Insurance' grant the Pension Fund of Ukraine (PFU) enhanced powers to scrutinize the justification for every benefit payment. The primary document remains the electronic sick leave certificate, and PFU regional offices will begin engaging specially authorized doctors to assess medical conclusions. This reform is part of broader efforts to modernize the social safety net and curb misuse of funds.

New Verification Procedures for Sick Leave

Under the new system, an electronic platform will randomly select cases for review, irrespective of region. If irregularities are found, the PFU must notify the medical institution or the doctor within 5 days. Medical facilities then have 10 days to either reimburse the amount or appeal the decision. A penalty of 0.1% per day will be charged for late repayment. A demand from the PFU is considered equivalent to an enforcement document.

Furthermore, hospitals are granted the right to recover financial losses from the doctor who issued an unjustified certificate.

“If a sick leave is deemed unjustified, the medical institution or the doctor will have to pay,” stated the authors of the amendments.

Paper forms will remain in circulation for situations where generating an electronic document is technically impossible. The procedure for issuing paper forms will be determined by the Ministry of Health of Ukraine. This provision for paper forms is valid during the period of martial law and for three months after its termination.

If an audit determines that a sick leave was issued without sufficient grounds, the PFU will inform the medical institution or doctor within 5 days. These changes are designed to increase doctors' accountability for issuing medical certificates and ensure more effective oversight of state funds.

The overhaul of sick leave monitoring represents a significant step toward improving Ukraine's social insurance system. The introduction of electronic certificates and strengthened PFU control aims to reduce instances of abuse and ensure a fairer distribution of state resources. Given that these rules take effect during an ongoing period of martial law, their implementation may impact how medical institutions and doctors balance administrative duties with patient care.

In light of these recent changes, the Ukrainian Health Service is also taking significant steps to ensure compliance among healthcare providers. For instance, the recent suspension of hospital payments due to violations related to doctor moonlighting highlights the ongoing efforts to eliminate fraudulent practices in the medical sector. To understand how these developments might affect the healthcare landscape and patient care in Ukraine, read more about the suspension of payments for hospitals.