Head of Medical Insurance Fund speaks out on embezzlement in the MSIS system
Tengrinews.kz — The Social Health Insurance Fund (FSMS) has responded to criticism following reports of ghost-patient schemes involving nearly 140,000 Kazakhstanis registered at clinics across various regions. The fund explained how it intends to strengthen oversight of insurance spending.
"No more covering up violations": Statement from the head of the fund
Gulmira Sabdenbek, Chairwoman of the Board of the FSMS, commented on reports regarding large-scale fraudulent schemes within the mandatory social health insurance (OSMS) system. On her Facebook page, she wrote that the fund has faced significant criticism in recent days.
According to her, a significant portion of the cases currently under investigation by law enforcement were identified by the fund's own specialists during routine audits.
Following these findings, the materials were handed over to law enforcement agencies.
"Our position is firm: we will not cover up violations, we will seek a legal evaluation of every confirmed fact, facilitate compensation for damages, and eliminate the conditions that allowed such schemes to exist," wrote the head of the FSMS.
Statistics: How many violations were detected
The fund's press service reported that in the first half of 2026, 72 cases of identified violations totaling 4.5 billion tenge were referred to law enforcement.
Based on the review of these materials, 27 criminal cases were registered, with the established amount of damage reaching 3.7 billion tenge..
"For comparison: in the entirety of 2025, 73 cases totaling 630 million tenge were referred, resulting in eight criminal cases," the statement read.
The FSMS believes the increase in the volume of detected violations does not indicate a rise in the number of abuses. Instead, they attribute it to stricter controls, improved analytical tools, and the fact that every identified instance is now pursued for legal action.
Changes to insurance expenditure oversight
The fund announced it is changing its approach to financial control. While violations were previously detected after funds had been transferred to medical organizations, the new focus will be on prevention prior to payment.
"As part of the fund's development strategy, a unified digital ecosystem for financial control is being implemented, including the Qalqan IT platform, an automated anti-fraud system, and risk-oriented data analysis algorithms," the FSMS noted.
Kazakhstanis will be able to independently check which medical services have been recorded under their name and report any services they did not actually receive.
The FSMS explained that such reports will serve as an additional source of risk indicators to be used during audits.
"Our goal is to make unjustified payments impossible before funds are even transferred to medical organizations. This will ensure the targeted use of every tenge and strengthen public trust in the OSMS system," commented Gulmira Sabdenbek.
The Financial Monitoring Agency recently uncovered schemes involving the fictitious registration of approximately 140,000 citizens at medical organizations, as well as the falsification of records for medical services rendered, leading to the illegal acquisition of funding from the Social Health Insurance Fund.
The agency specified that 36 criminal cases are being investigated regarding these facts, with the total established damage exceeding 3.5 billion tenge.