Court of Accounts
Republic of Moldova
On May 25th, 2018, the Court of Accounts (CoA) examined the Financial Audit Report on the Government Report on the Execution of Mandatory Health Insurance Funds (MHIF) in the 2017 budget year.
Mandatory health insurance is a state-guaranteed system for defending the interests of the population in the field of health protection by setting up funds to cover state treatment expenses caused by the occurrence of insured events (illness or affection). In order to offer to the citizens of the Republic of Moldova equal opportunities in obtaining timely and qualitative medical care, the mandatory health insurance system was established.
Audit evidences were collected at the National Health Insurance Company (NHIC) by analyzing and counterbalancing data from the information system, including the NHIC accounting records, as well as information received from third parties. Audit evidences were also collected at some public health care institutions.
According to the legal provisions, the National Health Insurance Company is a non-profit autonomous state organization with financial autonomy, which is obliged to carry out mandatory health insurance for the citizens of the Republic of Moldova and aliens in accordance with the legislative acts.
As a budget administrator, in the field of public finances, the Company ensures the management of MHIF finances and of public assets in accordance with the principles of good governance. The institution is also responsible for implementing health programs in line with the objectives and performance indicators assumed.
In this context, the Company organizes and keeps records of MHIF execution, according to the legal framework, and ensures the recording of operations on incomes and expenditures incurred, as well as debts paid up to December 31st , ensures records of transfers from the state budget, determines the result of MHIF execution through closure of revenues and expenditures accounts.
As far as reporting is concerned, the NHIC draws up the Annual Report on the execution of the MHIF and presents it to the Government and then to the Parliament for approval.
The objective of the audit mission was, on the one hand, to obtain reasonable assurance that the Government's report on the execution of MHIF in the completed budget year (2017) as a whole does not contain material misstatements as a result of fraud or error, and to express an opinion and, on the other hand, to provide the Parliament with an assurance statement that this report is presented in all material respects under the applicable reporting framework.
The findings set out in the Financial Audit Report on the Government's Report on the execution of Mandatory Health Insurance Funds in the 2017 budget year reveal the following:
• limitation of the auditor to expose and assess the volumes of contracted services rendered to the population, resulting from the lack of correlation between data related to the contracting and payment by the Company of the primary, pre-hospital and ambulatory emergency medical care and the reporting by medical institutions (2844,4 million MDL);
• inappropriate functioning of the automated information system "Compensated Medicines", the admission of inaccurate data processing as well as the inappropriate proceeding of primary documents storage ; all those factors do not fully ensure the possibility of evaluating the justification of expenditures in this chapter (1.1 million MDL )
• tariff application in the absence of adequate justification for payment of services provided in the hospital medical assistance (2522.2 million MDL);
• lack of adjustment and approval of the internal regulatory framework (including accounting policies) related to accounting and financial reporting of MHIF revenues, according to specific norms;
• dividing in an uncertain and unreasonable manner between the Ministry of Health, Labor and Social Protection and the NHIC the resources allocated to the Company to achieve disbursement indicators, as well as the lack of regulations on the delimitation of responsibilities between them;
• maintaining the trend of executing the fund for prevention measures and public health service providers’ development below the initial planning level, which may cause them not to achieve their goals.
The audit found that the Government's Report on the execution of MHIF in the 2017 budget year offered, in all material respects, a fair, correct and complete picture, excepting those issues that led to expressing a qualified opinion.
At the same time, it is reiterated the need to elaborate and approve policies related to the accounting and reporting of the MHIF, according to the financial autonomy status conferred and specific activity of the NHIC.
The audited entity is to inform the CoA about the implementation of the recommendations within 5 months of publication in the Official Gazette of the Republic of Moldova. The decision of the CoA shall be published in the Official Gazette of the Republic of Moldova, in accordance with art. 10 letter a) and art. 34 paragraph (2) of the Law of the Court of Accounts no. 260 of 07.12.2017.
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