Sicil, 2017/I Sayi 37: Sayfa 156-163
Metin KORKMAZ
Sosyal Güvenlik Uzmani
Sosyal Güvenlik Kurumunun 5510 sayili Sosyal Sigortalar ve Genel Saglik Sigortasi Kanunu kapsaminda yapmis oldugu ödemeler ve harcamalarin yersiz ödeme kapsaminda oldugu; mahkeme karari, Sayistay denetim raporu, Kurumun denetim ve kontrol ile yetkilendirilen memurlarinin inceleme raporlari veya Kurumun merkez ya da tasra teskilati birimlerinin incelemeleri sonucu tespit edilebilmektedir. Fazla veya yersiz olarak yapildigi tespit edilen her türlü ödeme ve masraflar Kanunun 96 nci maddesi hükmüne dayanilarak ilgili kisilerden geri tahsil edilmektedir. Ancak, Kurumca henüz konuya iliskin hükümleri ve yapilan kanuni degisiklikleri içerecek sekilde kapsamli bir ikincil mevzuat hazirlanmamistir. Bu durum; Kurumun merkez teskilatinda görev ve yetki çatismalarina, tasra teskilatinda ise güncel mahkeme kararlari ile uyusmayacak sekilde farkli ve kanuna aykiri uygulamalarin yapilmasina neden olmaktadir. Bu çalismada, yersiz ödeme kapsamindaki tedavi masraflarinin Kurumca tahsili asamasinda yasanilan sorunlar, mahkeme kararlari ve kanuni düzenlemeler çerçevesinde ele alinacak ve çözüm önerileri tartisilacaktir.
Yersiz ödemeler, sağlık masrafları, sahte sigortalılık, genel sağlık sigortalısı.
The payments and expenses borne by social security institution in accordance with the social insurance and universal health insurance law could be determined to be made in excess or redundant in case its found out on court judgments, Audit Court reports, or on examinations carried out by Institution’s officers with duty of inspection and control, or audit reports of courts of accounts, or examination of centrals units or provinces branches of institutions. Any kind of payments and expenses which is determined to be made in excess or redundant by the Institution shall be collected from the insurance holder or right holders in accordance with the provision of Article 96. Secondary legislation which contains the law amendments and making arrangements of the general rules related to this matter does not issued by Institution as yet. Under this circumstances, conflicting of authority and duty has been occuring in central organization, and implemantation of the article 96 by civil servants is giving rise to unlawfully process which is incompatible with latest court judgments. In this article the problems which the instutition encountered during collecting the health - care service expenses regarded as redundant payments is discussing in the framework of legal regulations and court judgments.
Inappropriate payments, health-care service expenses, unlawful insurance, universal health insurance.