"Legitimizing fake entries: Who is withdrawing billions from the accounts of Kazakhstan's citizens?"
The reason for contacting the National Social Medical Insurance Fund (FSMI) was a complaint from an editorial staff member regarding falsifications in the Damumed application. She accidentally discovered that doctors at one of the clinics in Almaty had systematically provided services to her underage daughter, even when the child was abroad with her parents. For instance, in November 2024, the girl received a variety of consultations, ranging from a surgeon and ophthalmologist to a dentist and otolaryngologist. However, the situation did not interest anyone (they didn’t even pretend): neither the leadership of the Almaty Public Health Department nor the fund. While the former simply remained silent, the latter limited themselves to stating that an official request from the patient or her official representative through the eOtinish platform was required for an unscheduled monitoring.
By the way, earlier the head of FSMI Abylkair Skakov stated that the responsibility for controlling falsifications in the field of medical services lies with the citizens of Kazakhstan themselves.
In the photo: Abylkair Skakov.
The former akim of Pavlodar region held the position of chairman of the board of the National Social Medical Insurance Fund since September 2023. In January 2025, it became known that Abylkair Skakov was leaving his post allegedly of his own accord. Currently, the duties of the head of FSMI are being performed by one of the deputies, Indira Sarkenova.
Let us remind you that in July 2024, the Supreme Audit Chamber conducted an audit of the fund. Auditors identified numerous violations of budgetary and other legislation, as well as internal regulatory documents. In October 2024, the SAC reported that 11 members of the management team of FSMI and its regional branches were held accountable, including one of the deputy chairpersons of the fund.
To Execute or Not to Execute
Meanwhile, according to the fund, hundreds of thousands of falsifications amounting to billions of tenge have been identified in Kazakhstan over the past five years. For instance, in 2020, 20,000 falsifications worth 209.4 million tenge were discovered; in 2021, 35,000 worth 240.7 million tenge; and in 2022, even more — 57,600 worth 400 million tenge.
“The year 2023 became a record year for the number of falsifications and the amount withdrawn. This year, 46,000 falsifications were identified, and the withdrawal amounted to 818.5 million tenge, which is almost twice as much compared to 2022,” notes the deputy chair of the board of the National Social Medical Insurance Fund Indira Sarkenova. “Moreover, in 2024, the number of falsifications slightly decreased to 43,300, while the withdrawal amounted to 550.2 million tenge, which is significantly lower compared to previous years. This may indicate an improvement in the effectiveness of preventive measures (QR codes, FaceID), as well as successful actions to reduce violations.”
As it turned out, in 90% of cases, “falsifications” occur during the provision of consultative and diagnostic services. The basic comprehensive capitation norm for primary healthcare for one attached person per month is 1,675.70 tenge. Payments are made considering adjustment coefficients, as clarified by FSMI.
Furthermore, the fund noted that they do not have the authority to revoke licenses from medical organizations for falsifications, but they can impose fines. No penalties are provided for incorrect information entry (not related to falsifications) as it is considered that this defect does not affect the fact and quality of medical assistance provided. However, for an unconfirmed case of medical assistance (services), the fine amounts to 300% of the cost of the “falsified” service. Over the past five years, medical organizations in Kazakhstan have been fined 2.3 billion tenge due to falsifications.
“These funds are then redistributed among medical organizations for priority medical assistance areas through procurement procedures. The five regions with the highest proportion of withdrawals from the procurement amount due to identified falsifications are Aбай and Ulytau regions, the city of Astana, and Mangistau and Zhambyl regions,” indicated Indira Sarkenova.
The Shop Won't Close
However, if the planned volumes of medical service procurement in the OMS system compel medical staff to resort to dishonest methods, then what is the purpose of setting these volumes and who bears the responsibility for poor planning in this case? FSMI did not provide a clear answer to this question. It turned out that requests for procurement plans based on needs are submitted by regional health managements. In planning the volumes of medical assistance, the authorized body, FSMI and its branches, local health management authorities, as well as personal medical data aggregators are involved. The corresponding volumes are approved by the authorized body and endorsed by FSMI before being communicated to its branches.
“Planning the volumes of medical assistance is carried out in accordance with budget legislation, regulatory legal acts of the authorized health body (standards for each type of medical assistance), rules for planning the volumes of medical assistance under the MHI and in the OMS system based on the need for types of medical services in dynamics, considering priorities in accordance with strategic plans, regional development programs, socio-economic development forecasts, and regional target indicators,” explained the deputy chair of the board of FSMI. “A radical solution to the problem of falsifications is complicated by the lack of control from the leadership of medical organizations and the difficulty of identifying violations, especially when the patient is uninformed about the services provided. Additionally, the disinterest of employees themselves also creates barriers to effectively resolving the issue, which requires a comprehensive approach, enhanced oversight, and increased penalties.”
The fund claims that only “deep digitalization of the healthcare system as a whole” can solve the problem of falsifications (however, this raises the question: is the fund's leadership confident that this will not become yet another feeding trough and that part of the budget allocated for these purposes will not end up in someone's pockets).
Currently, according to Indira Sarkenova, FSMI proposes to tighten measures against medical organizations by amending regulatory legal acts to intensify measures against those where falsifications are identified. This includes the transfer of information on falsifications to law enforcement agencies in cases where the amount of violations exceeds 200 MRP and the termination of procurement contracts in case of repeated violations (1 MRP in 2025 is 3,932 tenge, 200 MRP is 786,400 tenge).
“In December 2024, a plan of organizational measures to improve the monitoring of the quality and volume of medical assistance was developed and approved, which, along with other measures, aims to reduce the incidence of falsifications. Last year, changes were made to the joining agreement that allow the fund to officially publish data on unscrupulous suppliers, including a list of notorious “falsifiers” on the fund's website,” FSMI promised.
Toxic Schemes
Meanwhile, Olzhas Abishev, the former vice minister of health of Kazakhstan and now an independent healthcare expert familiar with the system from the inside, believes that “falsifications are becoming a convenient tool for siphoning off budget funds.”
In the photo: Olzhas Abishev (was the deputy of the former Minister of Health of Kazakhstan Yelzhan Birtanov from 2018 to 2020).
“Falsifications in the healthcare system are not random errors or forced measures from medical organizations, but the result of systemic schemes for embezzling budget funds. Financing of medical organizations through the National Social Medical Insurance Fund (FSMI) is structured in such a way that it creates favorable conditions for falsifications. Funds are allocated through advance payments, and control over their actual expenditure remains formal and on paper. As a result, falsifications become a convenient tool for siphoning off budget funds,” he explained while answering questions from the Total.kz editorial team.
Olzhas Abishev poses the question: why, despite the increase in the number of falsifications and colossal amounts of damage over the past four years, has no one been punished?
“The answer is simple: these schemes are beneficial to those who organize and cover them. Falsifications are not the problem of individual doctors or hospitals; they are a well-established process for appropriating budget money without real punishment for the participants,” shares the expert's opinion. “The system remains the same, and no inspections or identification of falsifications will change the situation. Total digitalization of all processes, including financing, independent control, and real accountability for those who organize these schemes is necessary. Without this, falsifications will only increase, and budget money will be appropriated into someone’s pockets instead of going towards real medical care for the population.”
According to him, the leadership of FSMI and the Ministry of Health of Kazakhstan is well aware of the problem of falsifications and the scale of embezzlement, but