o:9290 Prevencije i sankcije od prevara u zdravstvenom osiguranju Prevention and sanctions against health insurance fraud sr Sažetak: Autori u ovom naučnom radu prikazuju realno stanje u borbi protiv prevara, kao i lakših i težih oblika kriminaliteta na srpskom tržištu zdravstvenog osiguranja kako iz pogleda prava pacijenata, tako i iz ugla zaposlenih u zdravstvenim ustanovama, i u osiguravajućim kompanijam koje dopunjavaju državni zdravstveni sistem u sektoru privatnog zdravstvenog osiguranja u skladu sa domaćim i međunarodnim pravnim propisima. Autori prvenstveno analiziraju preventivni rad osiguravajućih kompanija i svih oblika medicinskih ustanova u borbi protiv prevara u osiguranju sagledavajući pravne propise i savremenu praksu u svom radu. Privatno zdravstveno osiguranje je posebno aktuelno i podložno različitim oblicima manipulacija i nepravilnosti u radu, obzirom na činjenicu da je svetska kriza u toku, kao i veliki broj migranata koji da bi prijavili svoj boravak „moraju“ da ugovore određene vrste polisa privatnog zdravstvenog osiguranja, a koje opet podležu različitim pokrićima koje nude osiguravajuče kompanije i veoma su podložneraznim oblicima zloupotreba i protivpravnoj eksploataciji. Državno zdravstveno osiguranje je poseban segment koji autori obrađuju. Jer se u njemu u zadnje tri decenije ne vide jasni i konkretni pozitivni pomaci na ovim poljima, Svaka osiguravajuća kompanija u regionu vodi svoju evidenciju fizičkih i pravnih slica u „bonus-malus“ sistemu potrošnje polisa osiguranja, medjutim, kvalitetnije rešenje ne postoji, jer nije formirano veće „telo“ poput evidencije za „bonus-malus“ na nivou Evropske Unije koje bi pratilo ovu vrstu osiguranju kao što je to sjajno uređeno za polise od obaveznog osiguranja od autoogovornosti, gde se „štetnici“ prate godinama u nazad i kažnjavaju pri novim sklapanjima ugovora o osiguranju. Autori svakako prikazuju benefite uvođenja ovakvog sistema praćenja polisa zdravstvenog osiguranja pri udruženjima osiguravača Evropske unije i Balkana, koji bi sarađivali i objedinjavali elektronske podatke osiguranika ( fizičkih i pravnih lica) kako za državno zdravstveno osiguranje, tako i za privatno zdravstveno osiguranje , a konkretno bi se povezalo Ministarstvo zdravlja sa svim lekarskim komorama, udruženjima osiguravača Evropske unije i Balkana, sa svim pojedinačnim članovima osiguravajućih tržišnih učesnika, kao i sve medicinske ustanove koje pružaju medicinske usluge (od najjednostavnijih do najkompleksnijih) a sve u skladu sa važećim pozitivno pravnim, domaćim i međunarodnim propisima i sankcijama koje uređuju ove oblasti. U drugom delu naučnog rada autori obrađuju prava medicinskih radnika u odnosu na osiguranje u skladu sa posebnom vrstom osiguranja – opšta i profesionalna odgovornost lekara koju obavljaju, a koja je izuzetno podložna zloupotrebama, pa mnoge osiguravajuće kompanije u Republici Srbiji ne prodaju ovu vrstu osiguranja. Prva osiguravajuća kompanija u Republici Srbiji koja je uvela ovo osiguranje je bila Basler osiguranje ado Beograd, a posle njene propasti portfolio je preuzelo Uniqa osiguranje ado, koje je ove polise osiguranja liderski prodavalo, ali količina isplaćenih šteta ih je navela da modifikuju ovaj proizvod i da uvedu svoju evidneciju „bonus-malus“ klijenata medicinara. Rad sadrži i primere ove vrste polisa koje u sebi sadrže pokrića od građansko-pravne i krivično-pravne odgovornosti lekara. U trećem delu naučnog rada autori se dotiču aktuelnosti i izazova sa kojima se susreću gore navedeni učesnici u zdravstvenom osiguranju, kao i sankcijma koje se odnose na njihov rad. Na kraju, zanimljiv je i niz afera koje se kao prva asocijacija pojavljuju običnom čoveku kada se pomene medicinsko i krivično pravo, ali ruku na srce, ipak treba svetlo gledati u budućnost i na najbolji način kroz alate koji postoji u medicinskoj, krivičnoj i osiguravajućoj struci izvućo najbolji i najkvalitetniji maksimu za dobrobit budućih generacija koje nam dolaze, pa i za bolje sutra svim građana kako Republike Srbije, tako i celog sveta. Abstract: In this scientific paper, the authors present the real situation in the fight against fraud, as well as lighter and heavier forms of crime on the Serbian health insurance market, both from the point of view of patients' rights, and from the point of view of employees in healthcare institutions, and in insurance companies that supplement the state healthcare system in the sector private health insurance in accordance with domestic and international legal regulations. The authors primarily analyze the preventive work of insurance companies and all forms of medical institutions in the fight against insurance fraud, looking at legal regulations and contemporary practice in their work. Private health insurance is particularly current and subject to various forms of manipulation and irregularities in work, given the fact that the world crisis is ongoing, as well as the large number of migrants who, in order to register their stay, "have to" contract certain types of private health insurance policies, and which again are subject to different coverages offered by insurance companies and are very susceptible to various forms of abuse and illegal exploitation. State health insurance is a special segment that the authors deal with. Because in the last three decades, no clear and concrete positive developments in these fields can be seen. Every insurance company in the region keeps its records of physical and legal figures in the "bonus-malus" system of insurance policy consumption, however, there is no better solution, because a larger "body" such as the "bonus-malus" registry has not been formed at the European Union level to monitor this type of insurance, as it is brilliantly arranged for compulsory auto liability insurance policies, where "pests" are tracked for years back and punished at by concluding new insurance contracts. The authors certainly show the benefits of introducing such a system of monitoring health insurance policies at the insurance associations of the European Union and the Balkans, which would cooperate and unify the electronic data of the insured (natural and legal persons) both for state health insurance and for private health insurance, and specifically connected the Ministry of Health with all medical chambers, insurance associations of the European Union and the Balkans, with all individual members of insurance market participants, as well as all medical institutions that provide medical services (from the simplest to the most complex), and all in accordance with the valid positive legal, domestic and international regulations and sanctions governing these areas. In the second part of the scientific work, the authors deal with the rights of medical workers in relation to insurance in accordance with a special type of insurance - the general and professional liability of doctors that they perform, which is extremely susceptible to abuse, so many insurance companies in the Republic of Serbia do not sell this type of insurance. The first insurance company in the Republic of Serbia to introduce this insurance was Basler osiguranje ado Beograd, and after its collapse, the portfolio was taken over by Uniqa osiguranje ado, which sold these insurance policies as a leader, but the amount of claims paid out led them to modify this product and introduce their "bonus-malus" records of medical clients. The paper also contains examples of this type of policy that includes coverage against the civil-legal and criminal-legal liability of doctors. In the third part of the scientific paper, the authors touch upon the current affairs and challenges faced by the above-mentioned participants in health insurance, as well as the sanctions related to their work. Finally, the series of affairs that appear as the first association to an ordinary person when medical and criminal law are mentioned is also interesting, but hand on heart, we still need to look to the future in the best possible way through the tools that exist in the medical, criminal and insurance professions. extracted the best and highest quality maxim for the benefit of the future generations coming to us, and for a better tomorrow for all citizens of the Republic of Serbia and the whole world. Napomena: Inicijalno je uneta pogrešna licenca. Ispravna licenca: Bez licence - direktna primena zakona Datum korekcije: 27.04.2026. Izmena se odnosi isključivo na licencu i ne utiče na sadržaj dokumenta. Note: The wrong license was initially entered. Correct license: No license - direct application of the law Date of correction: 27.04.2026. The change applies only to the license and does not affect the content of the document. Ključne reči: medicinsko pravo, prava pacijenata, zdravstveno osiguranje, lekarska odgovornost Keywords: medical law, patients' rights, health insurance, medical liability 1552101 2744-2799 2026-04-01T10:36:01.962Z 44 yes 46 Vladimir Šipovac Univerzitet Privredna akademija, Fakultet za ekonomiju i inženjerski menadžment person 0000-0002-8361-3325 Nenad Bingulac Univerzitet Privredna akademija, Pravni fakultet za privredu i pravosuđe, Novi Sad, Srbija person 22682215 0000-0003-1187-7054 Dejan Logarušić Univerzitet privredna akademija u Novom Sadu, Pravni fakultet za privredu i pravosuđe, Novi Sad, Srbija person 0000-0001-9782-9277 Miloš Lakičević Univerzitet privredna akademija u Novom Sadu, Pravni fakultet za privredu i pravosuđe, Novi Sad, Srbija person 0000-0002-0172-1171 application/pdf 723323 https://unilib.phaidrabg.rs/o:9290 no yes 16 70 1552253 211A01 Časopis za kriminalističku, kriminološku i pravnu teoriju i praksu 3 3 103 110 2024