The IT system of the Health Fund (FZOM) has consistently exhibited significant weaknesses. It lacked a coherent strategy and sufficient staff, and relied on an outdated server infrastructure. These issues culminated in a cyber attack on the Fund’s IT system in 2023. Additionally, FZOM showed deficiencies and irregularities in the process for referring patients for treatment abroad, as revealed by the final audit report from the State Audit Office (SAO).

The SAO expressed a qualified opinion regarding the accuracy and objectivity of FZOM’s financial statements and the compliance of financial transactions with relevant legislation for 2022. The audit encompassed both the financial statements and a compliance review of the Health Insurance Fund of the Republic of Macedonia for the year 2022, according to the report.

The audit continuously highlights deficiencies in the control activities related to health services in medical institutions, which are neither properly established nor implemented. As a result, there is no full verification of the invoices for performed health services. The lack of a unified integrated system for issuing referrals, medical reports, and calculations for health services, which form the basis for monthly invoices and reports, further increases the risk of errors and omissions.