New text: an NFZ inspection in Koszalin.

There is a new text on the site: NFZ inspection: a few months out of several years. It shows how the National Health Fund (NFZ) checks hospital billing, on the example of the neurosurgery department of the Provincial Hospital in Koszalin. The case was uncovered, researched and described by nicolabo, author of the site Hospitalizacje w Polsce (“Hospital stays in Poland”) — in an article and in a film on X. We present the results of that investigation and analyses; we checked the figures against the NFZ source data.

What follows from it

• Payment depends on how the stay is described. Spinal surgery with an implant (group H52) is valued at 15,040 points; the same surgery without an implant (H53), with a stay shorter than one day, at 9,225 points.
• The pattern is visible in open data. In 2021–2023 about 91% of H52 stays in Koszalin ended on the day of admission; in other hospitals, about 4%. Since May 2024, right after the first inspection, the hospital has billed these procedures mainly as H53.
• The inspection checked selected months: of 40 months of mass H52 billing it covered 8, and none of the period after the change of code. The financial consequences of both inspections come to about PLN 8.5 million, or about PLN 5 for every PLN 100 reported in three groups of spinal procedures.

Open data will not replace an inspection of medical records. But they can suggest where to look — and make it possible to check whether the Fund takes the hint.