Ophthalmologist Knut Resellmo in Mo i Rana believed that a very special type of laser scan is a very good tool for detecting serious eye diseases at an early stage. In the course of 18 months, he carried out 10,000 such examinations on his patients. This corresponded to more than 70 per cent of all such surveys nationwide, news was able to reveal earlier this year. For each eye he examined, he was paid NOK 800 by the state. In less than two years, he had been paid 8.6 million public health kroner directly into his account – for just one type of examination. Under the scrutiny of Helfo In 2019, Helfo started to investigate whether Resellmo had breached the trust that the state places on private medical specialists who relieve the burden on the public healthcare system. Usually, it is less than one in ten eye patients who need a so-called OCTA examination, according to the health authorities. And the examinations are almost always done in a hospital. Ophthalmologist Knut Resellmo is adamant that this machine is the only way to detect disease at an early stage, and without this examination you will fall behind with the necessary treatment to stop or slow disease. Here OCTA operator Tommy Bostad. Photo: Lars-Petter Kalkenberg / news Based on 50 random patient records, Helfo concluded in 2020 that the ophthalmologist had run almost all of his patients through the laser scan, whether there was a need or not. Helfo described the ophthalmologist’s actions as “grossly negligent”. And that the examinations “mainly appeared to be screening examinations”. As a result, he had to pay back close to NOK 8 million to the state for what the authorities believe is unnecessary testing. In addition, the ophthalmologist lost the right to send bills to Helfo for the next three years, for his treatment of patients. The complaint against the decision Eye doctor Knut Resellmo himself has always denied that he engaged in unnecessary mass testing of his patients and thus exploited the system to get as much money as possible. He believes that he has solid professional documentation for his practice and assessment use. And is adamant that all the examinations were medically necessary. To be able to ward off disease and prevent patients from losing their sight. The doctor treated between 8,000 and 9,000 patients annually before he lost his right to reimbursement. Photo: Lars-Petter Kalkenberg / news He has appealed his cases to Helfo and later to the complaints body Helseklage, with support from the Medical Association. Here he demands that the state pay back the almost NOK 8 million it has had to pay. In addition, he will demand that the operating grant from Helse Nord, which has been lost, be replaced. Plus the lack of earnings the clinic would have received during a normal year. He also demands that he get back the favorable agreement to get money refunded from the state. Approved one bill Now the Health Appeal has concluded the case concerning repayment. Here, the ophthalmologist gets some success in his complaint. Nevertheless, 45 out of 50 investigations are still rejected by the Norwegian health authorities. – We have reviewed the documentation for the same 50 patients. We have come to a different conclusion than Helfo in that we have approved one case that Helfo disapproved. Furthermore, we have rejected one case that Helfo has approved, writes Helseklage in its decision. And further: – For the other cases, we have reached the same conclusion as Helfo, writes Helseklage. – We have changed the decision from Helfo in favor of complaints. The complainant is therefore entitled to cover significant costs that have been necessary to change the decision. This means that Helfo must recalculate the repayment amount. The decision means that the percentage of the sum of almost NOK 8 million must be reversed. This means that Resellmo will have to pay less money than in the original decision from Helfo. In addition, the ophthalmologist does not have to pay court costs. It is not known how much the ophthalmologist will be reimbursed. The case has now been sent back to Helfo, which will carry out the calculation. The new case will be decided next year news has today been in contact with Knut Resellmo. He does not want to comment on the decision. – We are awaiting an assessment from the Medical Association, and beyond that I have no comment. The decision made by Helseklage is final. This means that it cannot be appealed further. However, the case can be brought before the court for judicial review. Ophthalmologist Knut Resellmo has previously told news that if he loses, he will take the case to court. The ophthalmologist’s second complaint, which concerns the loss of the right to reimbursement, will not be decided until next year.
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Ophthalmologist Knut Resellmo was partially upheld by the Health Appeal – news Nordland
