Publication date: 29.04.2024
active and purposeful military lawyer with more than 4 years of experience
We will remind that the PFU decided on a control mechanism in the field of hospital circulation: the resolution of the Pension Fund of Ukraine of October 19, 2023 No. 45-1 "On approval of the Procedure for monitoring the electronic register of sick leaves" (hereinafter - Procedure No. 45-1) — the document is not yet entered into force.
In particular, one of the reasons for conducting the inspection is the detection of inconsistencies based on the results of risk-oriented monitoring of the electronic register of disability certificates using the automated information and analytical system of the Pension Fund of Ukraine in accordance with paragraph 5 of the Procedure for conducting checks of the validity of issuing and extension of sick leaves, approved by Resolution No. 185 of the Cabinet of Ministers of Ukraine dated March 3, 2023.Procedure for leaf monitoring
incapacity
Therefore, monitoring is carried out by systematically processing the information of the electronic register of incapacity for work on the number, reasons, duration of registered incapacity for work by insured persons, business entities, persons who have certified temporary incapacity for work, policyholders, identifying changes (positive or negative), inconsistencies and determining factors influencing them, according to the following key principles:
• systematicity and systematicity;
• transparency of monitoring procedures and openness;
• security of personal data;
• objectivity of receiving and analyzing information;
• responsible attitude to their activities of persons participating in the preparation and implementation of monitoring.
What can be interpreted as a violation
The criteria for the risks of possible violations are given in clause 4 of Order No. 45-1:
1) 5 or more individual cases of temporary incapacity for work with continuous provision of incapacity for work leaves to the insured person;
2) 5 or more business entities, whose doctors issued a medical opinion on temporary incapacity for work (hereinafter referred to as "MVTN") of the insured person for one case of temporary incapacity;
3) MVTN was formed by a doctor in respect of whom, according to the results of inspections for the past 6 months, a case of unjustified issuance or extension of a certificate of incapacity for work has been established;
4) inconsistency of the duration of the period of temporary incapacity for work during the formation of the MVTN, provided for in the Procedure for the formation of medical opinions on temporary incapacity in the Register of medical opinions in the electronic health care system, approved by the order of the Ministry of Health of Ukraine dated June 1, 2021 No. 1066 (hereinafter - the order No. 1066) and the Procedure for Organization of Examination of Temporary Disability, approved by Order No. 189 of the Ministry of Health of Ukraine dated April 9, 2008 (as amended by Order No. 1066);
5) increase for the reporting period (month / quarter) of the percentage of temporarily disabled employees in the total registered number of employees of the insured with the number of employees:
• more than 1,000 people — more than 20%,
• from 500 to 1,000 people — more than 30%,
• from 200 to 500 people — more than 40%,
• from 50 to 200 people — more than 50%,
• from 10 to 50 people — more than 60%;
6) MVTN with doctor's notes on the presence of:
• alcoholic and/or drug intoxication as a cause of temporary incapacity;
• violation of the treatment regime;
• connection of the case of temporary incapacity with the professional activity of the patient.
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Working with inspection results
The results of automated monitoring are generated by software according to the forms given in the appendices to the commented document.
The generated results are analyzed by specialists of structural subdivisions that ensure the implementation of functions for checking the validity of issuing sick leave.Based on the results of this analysis, a report is drawn up, which should contain a conclusion on the need to carry out checks on the validity of issuing and extending disability certificates and documents, which are the basis for their formation.
In the event that, as a result of the monitoring, incapacity leaves are revealed that require further verification, the territorial body of the PFU within one working day makes a decision on conducting the verification and makes a note in the grounds for the verification - "Based on the results of data monitoring" (clause 5 of Order No. 185) .
Also, the relevant structural unit of the PFU must summarize the results of monitoring every quarter (clause 4 of Order No. 45-1).
