Health Insurance Audits in the Czech Republic: What Entrepreneurs Need to Know.

Health insurance companies in the Czech Republic have the right to audit insurance premium payers, including individual entrepreneurs and small businesses. These checks ensure compliance with insurance regulations and help maintain the integrity of the system. Understanding when and how these inspections occur is crucial for entrepreneurs in the Czech Republic.

There are two primary types of inspections:

Routine Inspections: Scheduled in advance, these inspections follow a predetermined plan.

Unscheduled Inspections: These may be triggered by unusual payment fluctuations, suspected non-compliance reported by other institutions, or other red flags.

Notice of Inspection

As mandated by Czech law and confirmed by Všeobecná zdravotní pojišťovna (VZP), insurers must provide written notice to the insurance premium payer at least two weeks prior to the inspection date.

Location of Inspection

Inspections typically take place at the insurance premium payer’s business premises. However, they may be conducted elsewhere if deemed more convenient or necessary to fulfill the inspection’s purpose. This could include a branch of the insurance company for individual entrepreneurs or smaller employers.

Responsibilities of the Insurance Premium Payer During the Audit

Czech law outlines specific responsibilities for insurance premium payers during a health insurance audit. These include:

• Documentation: Providing all accounting records and other documents relevant to the calculation of insurance premiums and any additional documents requested by the inspecting official.
  
• Transparency: Fully disclosing all necessary information and refraining from concealing any relevant documents.
  
• Cooperation: Offering explanations (orally or in writing) if questions arise regarding the accuracy or completeness of the provided documentation.
  
• Accommodation: Ensuring a suitable workspace and conditions for the on-site inspection.
  
• Off-site Documentation: If required, provide the necessary documents to review the business premises.
  

After the inspection, an inspection report is drawn up. VZP concludes that it is a mandatory basis for the legal consequences of the audit, including issuing a certificate of debt, initiating administrative proceedings, and issuing a payment order.

Understanding the process and potential outcomes of health insurance inspections is essential for entrepreneurs operating in the Czech Republic. By adhering to insurance regulations and fulfilling the outlined responsibilities, businesses can avoid potential penalties and ensure smooth operations.

Need Assistance?
If you have questions about health insurance compliance, accounting, or any other facet of running a business in the Czech Republic, 360 WEDO is here to help. Our team of experienced professionals provides comprehensive accounting, tax support, and consulting services. We are dedicated to solving your business challenges and helping you navigate the complexities of Czech regulations. Contact us to learn more.

Sources 

https://www.podnikatel.cz/aktuality/k-osvc-muze-dorazit-kontrola-z-pojistovny-jaky-muze-mit-duvod/