SP: expenses for the activities of the TFOMS require greater efficiency

As of early 2025, there were 139 branches operating in Russia, part of 28 TFOMS (compulsory medical insurance funds) in 80 regions. Regionally, the number of branches could reach 13 (for example, in the Republic of Dagestan and the Irkutsk Region). Last year, expenses excluding salaries amounted to 245 million rubles.

After assessing ten branches of the Krasnodar Territory's Federal Compulsory Medical Insurance Fund (FFOMS), the Accounts Chamber concluded that all their functions could be performed using electronic document management and information systems. As a result, annual savings after optimization could reach up to 25 million rubles. The fund also identified risks of overstating labor costs: the actual number of employees exceeded the standard number calculated according to the FFOMS's methodological recommendations by 29.

The Accounts Chamber also established facts indicating a perfunctory approach by officials at some territorial funds to monitoring the activities of medical insurance organizations and the quality of medical and economic assessments. Auditors identified instances where a single specialist could review between 2,000 and 85,000 assessments per day.

The Accounts Chamber also found certain shortcomings in the operations of the Federal Compulsory Medical Insurance Fund. According to the auditors, the Federal Compulsory Medical Insurance Fund did not fully exercise its authority in monitoring compliance with legislation by participants in the regional compulsory medical insurance system, including monitoring the volume, cost, and payment terms of specialized medical care provided on a planned basis in inpatient settings to patients insured under compulsory medical insurance in another region.

Following the cost-effectiveness assessment, the Accounts Chamber identified a set of requirements for the entities subject to audit and issued recommendations. For example, the Chairperson of the Federal Compulsory Medical Insurance Fund was instructed to conduct an unscheduled audit of territorial funds by December 1, 2025, to verify the accuracy of information on insured persons and, if necessary, to ensure the recalculation of subsidies for 2025. The Krasnodar Krai Territorial Fund was recommended to analyze the need for branch operations and optimize their number. The Prosecutor General's Office of the Russian Federation was instructed to conduct oversight activities in cases where a single specialist at a medical insurance organization performed significantly more assessments than expected. The Federation Council and the State Duma are also expected to receive the audit report.

In March 2025, the Accounts Chamber compiled a report on the execution of the Federal Compulsory Medical Insurance Fund's budget for 2024. The published data shows that over the course of the year, over 42.5 billion rubles, not included in the original subsidy amount, were transferred from the Federal Compulsory Medical Insurance Fund's standardized insurance reserve (NAR) and from the federal budget to the regions for the provision of compulsory medical insurance. The largest tranche, 40.4 billion rubles, was allocated from the NAR by government decision in December 2024 – traditionally due to a shortage of planned subsidies to maintain wage levels under the presidential decrees issued in May.