# North Macedonia healthcare sector investigation

> Developing situation record from CLSTR: https://clstr.news/situations/north-macedonia-healthcare-sector-investigation
> Updated: 2026-10-29T09:03:45.000Z. Sources: 33. Developments: 2.

The healthcare sector in North Macedonia has come under scrutiny regarding the costs and accessibility of medical services. Patients have frequently navigated a choice between long wait times in the public system and the high costs of private medical services, where diagnostic packages and specialist examinations can significantly impact family budgets.

This situation escalated into a major criminal investigation as police conducted raids at more than ten locations across Skopje, Tetovo, and Kumanovo. The probe targets former officials from the Health Insurance Fund (HIF) and management from a private hospital, including former HIF director Den Donchev. Authorities are investigating allegations of fraud, money laundering, and abuse of office. Preliminary estimates suggest the state budget may have been damaged by over 1.5 million euros, while a private hospital, Sante Plus, may have gained approximately 4 million euros in illicit profits through fictitious or inflated invoices.

There are also concerns that vulnerable citizens were forced to pay for medical services that should have been covered by insurance. The investigation specifically examines suspected double-billing, where services were paid for by the HIF and subsequently charged again to patients at private rates. Authorities are examining potential harm to a large number of patients, specifically regarding eye surgeries, with reports suggesting the scheme may have affected between 3,000 and 4,000 patients.

Criminal charges have been filed against 11 individuals and one legal entity for offenses including abuse of official position, fraud, money laundering, and falsification of business books. During the police operations, eight individuals were taken into custody and approximately 50,000 euros in cash was seized. One suspect, Bilal Kara, is reportedly wanted by Albania for separate tax evasion charges.

## Claims

- The damage to the state budget exceeds 1.5 million euros. (reported by 17 sources)
- The illegal material gain for the private hospital is estimated at approximately 4 million euros. (reported by 16 sources)
- Suspects include former Health Insurance Fund Director Den Dončev. (reported by 20 sources)
- The investigation involves suspected double-billing of healthcare services to both the Fund and patients. (reported by 17 sources)
- Police are conducting raids at more than ten locations in Skopje, Tetovo, and Kumanovo. (reported by 15 sources)
- The investigation includes suspected illegal activities related to eye surgeries. (reported by 13 sources)
- The investigation covers crimes including money laundering and fraud. (reported by 13 sources)
- The private hospital involved is identified as Sante Plus. (reported by 8 sources)

## Timeline

### 2026-10-29: North Macedonia health fund investigation targets private hospital and officials

North Macedonian police are investigating a major healthcare fraud scheme involving double-billing for eye surgeries, affecting thousands of patients and costing the state millions of euros.

33 sources. https://clstr.news/cluster/north-macedonia-police-raid-health-fund-and-private-hospital

### 2026-10-15: North Macedonia private healthcare costs and accessibility

Patients in North Macedonia increasingly rely on private healthcare to avoid public system delays, facing costs ranging from 3,000 denars for basic exams to nearly 20,000 denars for MRIs.

2 sources. https://clstr.news/cluster/north-macedonia-private-healthcare-costs-and-accessibility

---
Cite as: North Macedonia healthcare sector investigation. CLSTR, https://clstr.news/situations/north-macedonia-healthcare-sector-investigation