The Health Insurance Organisation (HIO) is developing artificial intelligence tools and has launched a trial programme targeting the reuse of photographs across different claimed health services, as part of a broader effort to strengthen oversight of General Health System (GHS) compliance.
Stratis Matthaiou, a representative of the PASYDY civil servants' union, outlined two developments at a press briefing: automated vetting tools had intercepted around 200 million euros in fraudulent submissions before they could be processed during 2025, and the union's governing board had voted to endorse draft legislation that would introduce stricter penalties for such offences.
A specialised plan to counter system misuse is being drawn up and implemented by a committee under Matthaiou's leadership — a body established for that purpose by the HIO's board.
Across the preceding twelve-month period, the HIO's IT system activated its automated rule-checks roughly 2.2 million times, with those interventions collectively blocking the lodgement of claims assessed as erroneous or ineligible and carrying an indicative combined worth of €200 million. Matthaiou drew a distinction between that figure and recovered funds or established fraud, noting that blocking a claim does not, by itself, amount to evidence that fraud took place.
Audits covering roughly 855,000 claims valued at approximately 181 million euros during 2025 produced adjustments and recoveries totalling around 19 million euros, according to Matthaiou. Monetary penalties were levied across 46 separate cases, and two service contracts with providers were brought to an end.
Automated rule-sets, pre-payment spot checks, and targeted investigations form the backbone of the HIO's oversight approach, while work on advanced data analysis and AI-driven tools for flagging irregular activity continues in parallel. Work on the technical infrastructure and the reporting environment concluded during the initial phase.
A number of the instruments have reached the site and are currently undergoing assessment, with Matthaiou noting that digital tools help sharpen the focus of inspections and allow checks to be directed more precisely. Collaboration with overseas counterparts — spanning formal institutional partnerships and broader cross-border knowledge exchanges — has become a channel through which the organisation draws on expertise developed within more established health systems.
Audit findings feed back into the revision of operational rules and procedures, with the aim of heading off comparable cases going forward. Revised penalties carrying heavier consequences and administrative fines set at steeper levels both featured in the amending bill that board members approved.
Under the proposed changes, the HIO would gain a longer window in which to recover outstanding debts through offsetting. Matthaiou indicated that the proposed adjustments would expand the tools available for addressing violations, adding that any resource under protection would continue to be directed toward patient care.
Addressing misuse placed strain on the system — shaping how resources were distributed — and remained, in his view, directly tied to both the standard of care delivered and the long-term viability of the GHS.
Inspections span the full range of health-sector providers, taking in laboratories, pharmacies, hospitals, and both medical doctors and allied health professionals. Auditors concentrate on inpatient services — given the volume of spending involved — scrutinising patterns such as unwarranted referrals, over-reliance on diagnostic testing, billing code inaccuracies, and claims submitted without sufficient supporting documentation.
Each finding, Matthaiou noted, underwent both review and follow-up examination, ensuring that any action taken rested on a foundation of documented proof. Addressing misuse, he argued, falls beyond the remit of healthcare providers alone — with access to services, diagnostic tests, onward referrals, and treatment properly grounded in verified clinical need and the professional judgement of those with medical expertise.
Matthaiou told patients they are expected to defer to clinical judgement and avoid pushing for treatments that healthcare providers have not determined to be medically warranted. Patients were also asked to forward their feedback, recommendations, and any grievances directly to the HIO.
Complaints and other input are channelled into a review process through which the organisation pinpoints operational gaps, examines potential irregularities, and refines how its services are delivered.
