Israel Tax Authority probes doctors accused of medical tourism corruption

Senior surgeons suspected of taking under-the-table payments from medical tourists. The Israel Tax Authority opened an investigation Tuesday into suspicions that senior doctors are taking under-the-table payments from medical tourists, while the Health Ministry asked the prosecution to consider ordering a police investigation into the issue.

Both moves came in response to a report aired by “Uvda” (Fact), Channel 2 television’s investigative journalism program, Monday night. The report showed three senior surgeons at Tel Aviv’s Ichilov Hospital – Prof. Shlomo Constantini, Prof. Zvi Ram and Dr. Yossi Paz – demanding large sums of money from a journalist posing as an agent for medical tourists. Paz even told the “agent” he would give her a receipt for the payment.

Tuesday morning, tax authority investigators asked the “Uvda” crew for any material that would assist their probe. Later in the day, the investigators went to Ichilov to search for information.

The Tax Authority said it doesn’t comment on investigations. Attorney Navot Tel-Zur, representing Constantini and Ram, said he doesn’t wish to comment at this stage.

The Health Ministry made its request for a criminal investigation in a letter to the brand-new state prosecutor, Shai Nitzan.

“Unfortunately, the [television] report doesn’t leave much room for doubt regarding the nature of the transactions,” wrote the ministry’s legal advisor, Mira Huebner-Harel. “The responses that were quoted, including those of the doctors themselves, don’t alter the picture or remove the burdensome impression that emerges from the investigative report, and the filmed evidence supports this impression to a large extent.”

Huebner-Harel said she wanted maximum coordination between her ministry and the prosecution in investigating the matter “at every appropriate level, including opening a police investigation if you see fit … This coordination is necessary so that the different layers of action don’t clash or disrupt each other.”

“It’s superfluous,” the letter continued, “to point out the great severity with which the health minister and the Health Ministry’s management view this affair, and their determination to do everything necessary to put an end to any manifestation of ‘black-market medicine’ in government hospitals, and in general, and to bring the full force of the law to bear against anyone involved in unacceptable acts of black-market medicine. As noted, we will assist in and get behind any necessary action.”

Health Minister Yael German said the goings-on revealed by the “Uvda” report must be dealt with “at both the personal and the systemic level. On the personal level, everything must be done to put an end to any manifestation of black-market medicine in the health system. Therefore, the Health Ministry’s legal advisor has asked the state prosecutor to examine all necessary modes of action, including opening a police investigation. On the systemic level, the entire issue of medical tourism must be dealt with and regulated, and guidelines to ensure public welfare must be set. This is being done by a public committee that has been considering the problem and studying the issue seriously for several months already. Shocking as the investigative report was, we must ascertain the facts before making decisions.”

On Monday night, shortly after the report was broadcast, Hatzlaha, an organization involved in medical tourism, wrote to Attorney General Yehuda Weinstein, Police Commissioner Yohanan Danino and the tax authority to request that they open a criminal investigation into both the doctors featured in the report and Ichilov’s management. The letter was signed by the organization’s legal advisor, Elad Mann.

The Ometz organization, which promotes good governance, asked State Comptroller Joseph Shapira Tuesday to investigate the entire issue of medical tourism, charging that it “takes up a significant slice of Israel’s public hospitals, and the ones hurt by this are Israeli patients.”

Source: Haaretz

Israel’s medical tourism at the crossroads

Income from medical tourism increased sharply in 2011 and 2012 to reach $140 million in 2012, according to data collected by the Health Ministry and the non-government organization Hatzlaha.  The Israeli government is exploring whether to curb or regulate medical tourism; despite the revenue it brings in-with worries that locals could suffer. The ministry has a dilemma that many hospitals have cited commercial issues for refusing to co-operate with official enquiries on how many medical tourists they actually get, as nobody has been able to find out the real numbers.

 The public hospitals took in NIS 291 million from medical tourism in 2012. Health maintenance organization Clalit reported that its 10 hospitals had revenues of NIS 70 million from medical tourism in 2012. Hadassah University Hospital in Jerusalem had revenues totaling NIS 108 million.

Private hospitals, including Assuta in north Tel Aviv, also had sizeable revenue from medical tourism but refused to provide numbers. One estimate indicates that Israel’s hospitals had revenues of more than half a billion shekels from medical tourism.

The public hospital with the highest medical tourism revenues was Sheba Medical Center, Tel Hashomer, with NIS 130 million a year – up nearly 70% since 2010. It was followed by Ichilov Hospital, Tel Aviv, which had revenues of NIS 99 million (up 44% since 2010), and Beilinson Hospital, Petah Tikva, at NIS 39 million – a 490% increase over the figure from 2010.Other public hospitals with medical tourism revenue were Rambam in Haifa, with NIS 36.4 million in revenues; Assaf Harofeh Hospital, Tzrifin, at NIS 15.9 million; and Schneider Children’s Medical Center, with NIS 13.6 million.

A subcommittee within the health ministry has been set up in an attempt to regulate medical tourism, which has no government oversight or standards. Many attempts have been made to set standards and regulations for medical tourism- all have failed to happen. In May 2013 the committee said that medical tourism should account for no more than 10% of a hospital’s revenues from operations. But it has yet to submit its recommendations, so this limit is not official, and it may be impossible to enforce.

Medical tourism is a very sensitive issue for Israel’s health system. Every medical tourist admitted raises the question of whether that person is taking the place of an Israeli patient, particularly given that the hospitals are very overcrowded and the wait for treatment is long.

Medical tourists come primarily from the former Soviet Union and from Mediterranean nations. They visit for a fixed duration, and may receive treatment ahead of Israelis.

For hospitals, medical tourists are very attractive and lucrative patients. Hospitals charge them much more than they receive from Israeli patients, and one of the reasons some hospitals refuse to co-operate with the ministry is a suspicion that they greatly increase the prices for medical tourists- so increased revenue may not equate with increases numbers- but be due to severe price increases and a concentration on more expensive surgery. Unlike insurers, the medical tourists pay the hospitals immediately, and in cash. The money goes into the hospitals’ parallel business operations, as opposed to the budget subject to government oversight, which means the hospital directors have more control over the money.

Source: IMTJ