Corruption schemes in prosthetics. How to profit from people's grief

Every year, hundreds of Ukrainians who need prosthetic limbs have the opportunity to order them in Ukraine. This applies to both wounded soldiers and civilians, while the cost of prosthetics is fully covered by the state. During almost ten years of war, a large number of enterprises specializing in the production of prosthetics, including high-tech products, entered the market. However, not everyone has complete information about this opportunity.

Often the wounded or their families, in a state of passion, begin to raise funds for prosthetics. They are afraid that they will not be able to afford it on their own, because we are talking about hundreds of thousands or millions of hryvnia, depending on the complexity of the injury. Lack of information about your rights is one of the biggest shortcomings of the system.

Unfortunately, even on such an important topic as prosthetics for wounded soldiers, scammers and unscrupulous companies are still trying to get rich. Officials are in no hurry to close loopholes that have existed for years and still exist.

How does the state help provide prosthetics to wounded soldiers, what has changed in this system over the past year and what are the biggest problems that have not yet been resolved?

How the prosthetic system works
Persons with disabilities have the right to receive free aids that help their rehabilitation or daily life. The list of such means is wide: wheeled chairs, crutches, orthoses and prostheses.

In 2023, UAH 2.8 billion was allocated for this - twice as much as in 2022. Until November, we spent 2.2 billion UAH, of which 70% was on prosthetic and orthopedic products. The Ministry of Social Policy does not specify how much was spent on prosthetic limbs.

According to the Social Protection Fund for Persons with Disabilities, there are 60 enterprises in Ukraine that provide prosthetic limbs for budget funds. Of these, only seven take on complex cases and provide prosthetics with increased functionality.

Over the past year, the procedure for obtaining prosthetics for the military has been simplified. Public organizations “Principle” and “Prosthesis Hub” have developed detailed instructions for them.

The state allocates up to UAH 2 million per limb to wounded military personnel. If you need two or three prostheses, the cost of all is covered. This amount is enough to produce a high-quality, complex and functional prosthesis. Prosthetics themselves are not produced in Ukraine - they are made individually for each person, taking into account the needs and characteristics of the body. Some components are imported.

In recent years, there have been more opportunities for obtaining high-quality prosthetics in Ukraine, says Antonina Kumka, director of development and partnerships at Prosthetic Hub. The market is developing, partnerships are being established with new suppliers, specialists are improving their skills and learning to work with complex cases.

To receive a highly functional prosthesis, the wounded person needs to undergo a commission and confirm that he needs a certain type of prosthesis. This is not a whim, Kumka explains. If a person wants to return to sports, he needs one prosthesis, otherwise a “sports” prosthesis will only limit him.

The process from submitting an application to receiving a prosthesis takes about a month and differs significantly from the procedure that has been in effect until now. Previously, you had to go to hospitals to get IHC decisions, most of which were not adapted to the needs of people with disabilities. Now such documents can be obtained in the hospital during treatment.

In addition, the wounded had to receive a disability group, for which they had to undergo an even more bureaucratic medical and social expert commission (MSEC). All this took a lot of time, physical and moral strength. However, despite the improvement, this procedure still has significant shortcomings and corruption risks.

Firstly, when the wounded person gets acquainted with the list of enterprises, he receives dozens of company names. Some of them negotiate with CNAPs or social security authorities so that they offer the wounded their services, which are not always of the best quality. An inexperienced person will not even know that his rights are being violated.

Secondly, the catalog of auxiliary rehabilitation devices (ARD) includes hundreds of components for prostheses of different characteristics, manufacturers and price options. Understanding it is a serious task even for people involved in this area.

Thirdly, enterprises may deceive the wounded when choosing prostheses, for example, asking them to pay extra for a better product. If he agrees, the person pays additional funds to the cash desk of the company, which will receive the entire amount for the prosthesis from the state.

Abuses in the prosthetics system
Funds for the manufacture and installation of prosthetics continue to be stolen. Although attention to the prosthetic system has increased significantly, companies sometimes use blatant schemes.

Market participants and representatives of public organizations spoke about schemes in the ED prosthetic system. The Accounts Chamber conducted relevant audits, the last of which was during the great war. In addition, the National Agency for the Prevention of Corruption (NAPC) analyzed corruption risks in the prosthetics system. Below are some of them.

Cost manipulation. Prosthetics is a socially important service that is paid for by the state. It is logical that it has the right to demand that companies do not receive excess profits from them. True, instead of regulating the maximum markup on prosthetics, it regulates the profitability of enterprises - 5-9%.

At the same time, the legislation does not in any way limit prosthetic enterprises in the volume of administrative and sales expenses. In other words, a business may artificially inflate its costs to meet profitability requirements.

Sometimes this leads to absurd situations. For example, one of the enterprises included payment for marketing and representation services under 14 contracts amounting to UAH 10.3 million as expenses for the sale of agricultural products. Of course, they were paid for from the state budget.

Gasket companies. For each means of rehabilitation, the state sets the maximum allowable cost that it is willing to pay. There are several problems with this.

Firstly, the product codes do not match the international standards ISO 9999. That is, it is difficult for the state to determine what the maximum price of a prosthesis can be.

Secondly, the maximum cost set by the Ministry of Social Policy is too high. This allows prosthetic companies to artificially inflate prices. The company may purchase funds through a number of intermediaries. At each stage, the price of DZR increases, sometimes by 2.5 times compared to the manufacturer’s initial price.

Deception and substitution of details. Sometimes prosthetic companies promise a person that his product will contain the same parts, but installs less technologically advanced and cheaper ones.

“The most expensive part of the prosthesis is the knee joint. There are mechanical joints, and there are electronic ones. We have identified cases where a person is given a prosthesis with a mechanical joint, but is written off with an electronic one. The difference between them is hundreds of thousands of hryvnias, which are paid to the enterprise by the state,” says acting director. O. Chairman of the Accounts Chamber Andrey Maisner.

Dead souls. The most egregious cases are the issuance of medical certificates for deceased persons.

One of the enterprises entered false information into the acts of acceptance and transfer of work and “provided” prosthetics to deceased people for 8 million UAH.

The state does not track what happens to rehabilitation means after people die. By law, such DZR must be returned to the manufacturers. Some of them can be disassembled, and the parts can be used to make temporary prostheses.

This became possible because the Ministry of Social Policy has almost no control over the quality of services provided by prosthetic enterprises. Over the past 2.5 years, social protection authorities have not surveyed people who received DZR.

Sometimes a lack of feedback leads to businesses wasting resources. Persons with disabilities are provided with prosthetics of inadequate quality, manufactured without taking into account their anthropometric data. These products cannot be used, but the state still pays for their production.

Despite the large number of violations that prosthetic enterprises commit when serving people with disabilities, there is almost no mention of such cases in the court register. As a rule, people with disabilities do not know that their rights are being violated and do not turn to law enforcement agencies for help.

No proceedings were opened regarding the violations identified by the Accounts Chamber during the last audit. “It is difficult to prove violations. The perpetrators call the recipients of the DZR and “amicably” resolve the issue. People don’t understand that other people will suffer from the actions of unpunished entrepreneurs,” says Meisner.

What needs to be done
The problems of people with disabilities have often remained in a “gray” area. Such people can rarely be seen in cities or villages, because the streets are not suitable for their movement. In the end, the state’s attention to solving the accumulated problems in the prosthetics system is not enough even after the start of the war in 2014.

As a result, the prosthetics system entered the great war unprepared, bureaucratic and with a lot of abuse, which officials did not notice. Moreover, after February 24, 2022, the government took away the right of combatants to receive free high-tech lower limb prostheses. Such official negligence was corrected only in October 2023.

In July 2022, the Ministry of Social Policy decided to deregulate this market. They got rid of excessive control over prosthetic enterprises by eliminating the commission that carried out on-site inspections. Thanks to them, long-term corruption schemes were built that made it possible to block the work of “unprofitable” enterprises.

However, this improvement had its price: now the state can compensate the enterprise not only for the cost of the prosthesis, but also, for example, advertising services. There is no mechanism that would allow us to control what the state pays for.

Due to the chronic lack of government attention to the needs of persons with disabilities, Ukraine experiences an acute shortage of specialists. Prostheses are often made and installed by people without appropriate education, but with extensive experience.

Problems with personnel qualifications are sometimes solved by public organizations. “We saw that there is a critical shortage of specialists in upper limb prosthetics. We took five specialists from different fields and sent them to Sweden for two weeks of advanced training. They returned and the process began,” recalls Kumka.

True, it is hardly possible to achieve systemic changes with targeted solutions. Without drastic steps, it will be difficult to cope with the rapid increase in the number of people with amputations. Such people need not only to assemble and install prostheses, but also to carry out rehabilitation and maintain the products from time to time.

Although the war with Russia has lasted almost ten years, Ukraine only recently launched training programs for prosthetists in several universities. The Ministry of Social Policy also made a request for a state order for these specialties.

The state order for relevant professions will solve several problems. In particular, veterans or people who themselves have experienced amputation could study such specialties. In this way, the state could not only improve the quality of prosthetics services, but also employ people with disabilities.

Another problem is the lack of production of high-tech prosthetics in Ukraine. Enterprises can assemble artificial limbs from parts that are ordered abroad. As practice shows, often these parts are imported through intermediaries and while the product is on the way, its price increases several times.

Unfortunately, due to the great war, one of the world's largest markets for artificial limbs has formed in Ukraine. Even after the end of hostilities, the demand for prosthetics and maintenance of prosthetics will remain at a high level, given the scale of mining in the east and south of the country.

The world's leading manufacturers of remote sensing devices are interested in working in Ukraine, but military risks may hinder their entry into the market. Instead of attracting such investments, government institutions are trying to maintain the status quo, so that the import of prosthetic components continues to occur according to opaque schemes.