Unannounced Audits and Strict Limits for Doctors: NFZ Chief Reveals What the New Law Will Change

A newly proposed multi-faceted amendment to the healthcare services act grants the National Health Fund unprecedented regulatory powers, including unannounced hospital inspections, private practice audits, and a strict monthly employment cap for medical staff.

Unannounced Audits and Strict Limits for Doctors: NFZ Chief Reveals What the New Law Will Change

Unannounced visits to hospitals, schedule-and-finance scrutiny of private practices, and a rigid work limit of up to a maximum of two full-time positions per month. A multi-faceted bill amending the healthcare services act has been submitted for public consultation, equipping the National Health Fund with unprecedented authoritative powers. The payer will gain the ability to verify whether patients bypassing queues in the public system were not previously treated for a fee by the same doctors.

No More Audit Warnings: NFZ Enters Facilities Without Notice

The previous legal status significantly limited the effectiveness of verification activities undertaken by the state payer. As emphasized by NFZ President Filip Nowak, the current inspection apparatus lacks instruments to monitor on an ongoing basis the fatigue level of medical personnel or the connections between the public sector and doctors’ private practices.

Under the proposed provisions of the amendment to the act on healthcare services financed from public funds and certain other acts, the National Health Fund will be able to notify a medical entity of a planned inspection precisely at the moment it begins. Abolishing the obligation to warn the facility in advance about the inspection is intended to curb practices of masking organizational and staffing irregularities.

Insight Into Paid Visits and Scrutiny of Private Practice: A Reaction to Bypassing Queues

A key element of the reform is the extension of NFZ jurisdiction to the area of commercial services provided by entities holding contracts with the Fund. Medical facilities combining public contracts with paid activity will be legally obligated to provide the NFZ with complete data concerning paid services.

This action aims to directly verify whether patients admitted out of turn to hospitals or for publicly funded procedures did not previously use private consultations with the same doctors or department heads. The amendment is intended to eliminate the phenomenon of treating public hospital wards as an extension of private clinics.

A Maximum of 320 Hours Per Month: Employment Limits and Expansion of the Inspector Corps

The draft bill introduces a top-down limit on working hours for medical personnel—up to a maximum equivalent of two full-time positions (approx. 320 hours per month). Exceptions are provided only for services in emergency states during on-call duties and in situations requiring the continuity of treatment, which will require obtaining nominal NFZ approval issued for a period not exceeding 6 months.

In parallel, the Fund announces a gradual staffing expansion. The inspection corps established in 2022, currently numbering 115 inspectors and about 200–300 analysts, is to double its size over the next 10 years. To facilitate the recruitment of people with medical education, the bill assumes the abolition of existing restrictions preventing the employment as an inspector of people working simultaneously in the public healthcare system. The drafted regulations also contain provisions limiting remuneration levels, organizing contract conclusion rules, and increasing the powers of the Agency for Health Technology Assessment and Tarification (AOTMiT).