The General Healthcare System (GeSY) is entering the most critical digital initiative since its launch, as costs continue to rise and public demands for transparency reach new highs. In response, the Health Insurance Organisation (HIO) is deploying one of the most advanced technological tools available—Artificial Intelligence (AI)—investing €500,000 to analyse millions of data points related to doctors and other healthcare providers.

As Brief reports, with a budget approaching €1.5 billion, GeSY represents the largest financial pillar of the state. However, the persistent problem of abuse is draining valuable resources that could otherwise be allocated to innovative medicines and the reduction of waiting lists. The investment in AI is therefore not merely a technological upgrade, but a targeted financial clean-up operation.

The AI system, which is expected to be fully operational by 2027, with pilot applications already scheduled to begin in 2026, will act as a preventive “guardian”, intervening before any formal complaint is even filed.

According to sources within the HIO, the AI will analyse provider and patient behaviour in real time, identifying patterns and irregularities that are impossible for the human eye to detect.

The investigations will focus on sectors with the highest levels of irregularities:

First, providers displaying an excessive number of physiotherapy sessions will be immediately flagged, particularly when these do not align with their working hours or the patient’s medical condition.

Second, magnetic resonance imaging (MRI) and CT scans will be examined when referrals are not justified by the patient’s medical history.

Third, prescriptions will be monitored, especially in cases involving expensive branded medicines where generics are available, aiming to uncover possible suspicious connections.

The law is clear, and AI will significantly strengthen enforcement. The HIO has already demonstrated a tougher stance, imposing fines exceeding €90,000 in a single round of inspections. Under the new system, penalties will be applied on a graduated basis:

Suspension of payments: Any suspicious claim will be automatically frozen until clarified.

Recovery of funds: Amounts obtained fraudulently will be returned to the Fund through deductions.

Permanent exclusion: Providers found to be engaging in fraud will be removed from GeSY and referred to the justice system for criminal offences.

According to statements by officials, “the introduction of Artificial Intelligence into GeSY represents the last opportunity to safeguard the system’s sustainability. The technology will not be used to punish honest doctors or patients in genuine need, but to remove those who treat public healthcare as a field for profiteering. The countdown has begun, and this time, oversight will be absolute.”

Meanwhile, the government has already initiated amendments to the GeSY legislation, granting expanded powers to the Ministry of Health’s Supervision and Audit Unit to oversee spending and decisions made by the HIO. This move follows observations by the Audit Office regarding financial “gaps” in the system.

The new Minister of Health, like his predecessor, maintains that the state must retain the final say on the sustainability of the Fund, in order to prevent abuses before they evolve into structural deficits.