PROBLEMS OF CALCULATION AND CONFIRMATION OF DAMAGES CAUSED BY ILLEGAL ACTIONS OF SUBJECTS OF THE MEDICAL GUARANTEE PROGRAM

Abstract

The article examines one of the modern methods of committing criminal offences in the healthcare
sector, namely, entering false information into the “eHealth” electronic system through medical information systems on
the provision of medical services to patients under the medical guarantee programme, and highlights the problematic
aspects of calculating and confirming damages caused by illegal actions of the subjects of the medical guarantee
programme. The study used a combination of general scientific methods (analysis, synthesis, deduction, induction) and
special methods of scientific knowledge (special legal method, comparative legal method, historical and legal method,
sociological method, statistical method). The empirical basis is made up of the materials of 68 criminal proceedings,
as well as the results of the dissertation research. The scientific novelty of the article lies in the formulation of proposals
for regulating some issues of implementation of the programme of state guarantees of medical care for the population
in 2024 in terms of using other tariffs in packages of medical services instead of the tariff defined as the global rate.
In addition, the article reveals the peculiarities of budget financing of the healthcare sector introduced with regard to
the modern technological process, and analyses the mechanism of calculating tariffs under the programme of state
guarantees of medical care for the population. The author provides a comparative characteristic of the calculation in
the packages of medical services paid for at the tariff, where the following are applied: capital rate, rate per treated case,
rate per medical service, according to which payment for services is accrued and made for medical services provided
to certain patients in the current period. The author underlines that neither a forensic expert nor an auditor can
calculate the cost of such a medical service at the time of its provision, since the formula for calculating the global rate
is multi-component and contains elements that are unknown at the time of entering information into the electronic
healthcare system. The author proves that under such conditions both preparation for and attempted commission
of a criminal offence under Article 191 of the Criminal Code of Ukraine and an attempt to commit an offence take
place. The practical significance of the article is to improve certain provisions of current legislation with a view to
ensuring transparency of the use of the State budget funds allocated for the implementation of the medical guarantees
programme, establishing all the circumstances of a criminal offence, calculating the amount of damages caused, and
bringing the perpetrators to criminal liability.