Changes in GeSY: possible age limits for doctors and fines of up to €600,000

Changes to GeSY may include rules for admitting physicians to the system, billing audits, and penalties for violations. The Ministry of Health has submitted two draft bills for consultation. One proposal would allow the Health Insurance Organization, known as OAY, to set a maximum age for individuals providing services within the system.

These regulations are not yet in force. Public consultations will last until November 12, 2026, and the drafts may be amended. Their publication alone does not require a change of doctor or re-registration of patients. The proposed administrative penalties would reach €300,000, and for repeated violations, up to €600,000.

Changes in GeSY without a set age limit for doctors

The draft provides for the possibility of establishing an upper age limit for individuals who provide or intend to provide medical services at GeSY. However, it does not specify a specific age.

The regulation applies to a broader group of people than just general practitioners. At this stage, no common limit for individual professions or detailed rules for its application have been established.

This does not mean, therefore, that the designated group of senior doctors has a set date for their departure from the system. The proposal creates a basis for establishing such terms at a later date.

OAY could limit the admission of new healthcare providers

The first project gives OAY greater control over registration and contracting with physicians and other medical entities.

The organization could refuse admission to the system or make cooperation conditional on meeting certain conditions. These restrictions could also apply to healthcare providers already operating within GeSY.

Decisions would be based on an assessment of patient needs, service quality, public health protection, and the financial stability of the system. The proposal requires proportionality. Therefore, it is not a proposal to automatically close GeSY to all new doctors.

Higher fines and wider inspections

The second draft proposes increasing the maximum administrative fine from €30,000 to €300,000. Repeat violations could result in a fine of up to €600,000.

These are upper limits, not automatic rates for each violation. In the case of a repeat violation, the penalty would depend on its nature, severity, and duration.

The project also expands the ability to audit facilities and documentation, including electronically stored data. This audit could include compliance with clinical protocols, contract terms, and quality standards.

It is also possible to submit a written objection to the OAY council against the decision of the Director General on an administrative penalty within 30 days of notification.

Settlements under control even after 12 years

OAY would generally be able to verify paid receivables for three years from the payment date. If the violation resulted from intentional, fraudulent conduct, this period could be extended to 12 years.

The project would also allow for the determination of the debt of the healthcare provider and the deduction of amounts paid in breach of regulations, contract terms or medical principles adopted by the system.

So it's not just about imposing sanctions, but also about recovering money that should not have been paid.

Insurers would cover part of the treatment costs

A separate proposal concerns treatment for accidents and occupational diseases covered by mandatory insurance. Insurance companies would annually transfer to OAY amounts corresponding to a portion of GeSY's expenses.

The mechanism includes mandatory third-party liability insurance for road traffic and employers' liability. Contributions would be calculated according to an established methodology and distributed among insurers in proportion to their market shares.

This provision applies to settlements between the system and insurance companies. It does not establish a new patient co-payment for such treatment.

What should a patient know?

For those using GeSY, the most important thing is to distinguish between the draft being consulted and the adopted law. Based on the proposals alone, there's no need to change doctors or update your registration.

The Ministry justifies the reform with the need to improve the quality of care, enhance oversight, and protect the system's finances. The drafts may change after consultations. Only the adoption of the laws and relevant implementing regulations will determine how the new solutions will be implemented in practice.