Bünyamin Tekin

An ongoing trial involving 47 defendants accused of orchestrating a social security fraud scheme that caused the death of at least 10 newborns in private hospitals has brought Turkey’s healthcare system under intense scrutiny, exposing structural flaws that prioritize profit over patient welfare.

At the heart of the scandal, often referred to by Turkish media as the “newborn deaths gang,” lies Turkey’s Social Security Institution (SGK), the cornerstone of Turkey’s healthcare financing, which has become a target for exploitation through fraudulent claims and unethical practices.

In the case, 47 defendants, including hospital administrators, ambulance operators and doctors, are accused of orchestrating a scheme that led to newborn deaths. They allegedly manipulated emergency services, falsified medical records and billed SGK for unnecessary treatments in neonatal intensive care units (NICUs) at private hospitals. The scheme, outlined in a 1,399-page indictment, highlights the extent of corruption in Turkey’s healthcare system and raises questions about systemic failures that allowed such practices to thrive.

Just this morning, İstanbul police launched raids as part of an investigation into other people involved in the scheme, detaining 14 individuals, including five doctors, three nurses, five healthcare workers and one civilian. The investigation continues to shed light on alarming practices within Turkey’s healthcare system, where profit-driven motives have overshadowed patient care.

SGK’s role in healthcare financing

SGK, the state’s primary health insurance provider, plays a critical role in funding both public and private healthcare services. With a budget exceeding 2 trillion Turkish lira ($58 billion), SGK reimburses hospitals based on predetermined rates. While this system aims to provide equitable healthcare access, it has inadvertently created incentives for profit-driven practices.

Dr. Salih Gezer, a healthcare expert with extensive experience across various segments of Turkey’s healthcare system who chose to be identified with a pseudonym for security reasons, explains the inherent vulnerabilities of SGK’s reimbursement system.
“This system represent a major financial black hole. The state, through SGK, essentially purchases services from city hospitals, medical schools, public hospitals and private hospitals,” Gezer said.

“Patients can choose their doctors and hospitals, which initially seemed beneficial. However, the lack of a gatekeeping system through general practitioners created inefficiencies and overburdened hospitals. Unlike Germany, where family physicians handle most cases, minor health issues in Turkey often end up in hospitals, which burdens SGK and the system as a whole,” he added.

The financial strain on SGK has grown significantly in recent years. In 2023 SGK’s spending on private hospitals surpassed 34.5 billion lira, marking a 416 percent increase over 11 years. Despite fewer patients being treated at private facilities compared to public hospitals, SGK’s per-case payouts to private hospitals are disproportionately higher. This financial model has turned SGK into a “black hole,” as described by Gezer, draining public resources while enriching private entities.

The rise of profit-driven healthcare

The problems plaguing SGK are deeply tied to Turkey’s broader healthcare transformation, which began in 2004 under the Health Transformation Program. While the program initially aimed to expand access to healthcare, critics argue it paved the way for the commercialization of the system, prioritizing profit over patient care.

The number of private hospitals in Turkey has skyrocketed by 111.7 percent since 2002, and private facilities now dominate in specialized services such as NICUs. According to the Turkish Statistical Institute, private hospitals have more neonatal beds (7,330) than public hospitals (6,355).

Dr. Gezer highlights the consequences of this shift: “The government systematically weakened public hospitals by underfunding them and redirecting services to private facilities. This created a dependence on private hospitals, which exploit their position to charge both SGK and patients exorbitant fees.”

In addition to higher costs, private hospitals often engage in unethical practices to maximize profits. Dr. Yağız Serim, a healthcare professional with decades of experience who is also identified with a pseudonym due to security concerns, explains: “Hospitals comb through regulations to exploit loopholes and charge the state.”

“Let’s say you have pneumonia and visit a pulmonologist in a private hospital because you can’t get an earlier appointment at a public hospital. They order a hemoglobin test, a blood test, an X-ray, a CT scan, an ultrasound and even an endoscopy — sometimes entirely unnecessary. You end up paying thousands of lira, of which some portion is for the consultation, but most is for the tests. The doctor might take a 40 percent cut from the consultation fee and 10 to 20 percent from the tests. This incentivizes doctors to push for as many tests as possible,” Serim explains.

According to Serim, this leads to a dangerous trend where patients have been conditioned to demand MRIs or CT scans for the slightest issue.

“Someone might have had an MRI six months ago and think, ‘I’ll just get another one.’ It’s not just unnecessary — it’s harmful,” Serim says.

“I was shocked to learn about some of these practices. For example, I heard that a hospital in Bursa — allegedly with connections to the government and even rumored to involve Emine Erdoğan, the wife of Turkish President Recep Tayyip Erdoğan — conducted “check-ups” using MRIs and CT scans. They’d perform MRIs and CT scans on every patient coming in for a routine check-up. Can you imagine the radiation exposure for patients and the unnecessary expenses?”

In his 22-year rule, President Erdoğan championed healthcare reform as a signature achievement, earning widespread acclaim among his base for modernizing and expanding access to medical services.

Public hospitals were revamped, and citizens welcomed shorter wait times and more facilities.

However, the emphasis on increasing the quantity of care eventually came at the expense of quality. Overcrowded hospitals, rushed appointments and overburdened doctors became the norm, leading to a decline in the standard of patient care. What was initially celebrated as a leap forward in healthcare turned into a system overwhelmed by demand, leaving many questioning the sustainability of Erdoğan’s reforms.

The focus on performance metrics incentivized profit-driven practices, leading to overdiagnosis, unnecessary procedures and rampant exploitation of the Social Security Institution.

The broader culture of exploitation

The ongoing trial of the so-called “newborn deaths gang” offers a grim look at the extent of corruption in Turkey’s healthcare system.

Dr. Gezer describes the financial incentives driving such practices: “Private hospitals depend on high patient volumes to sustain their operations. By bribing ambulance operators and emergency call staff, the gang ensured a steady flow of patients to NICUs, where they could bill SGK at inflated rates.”

Prosecutor seeks arrest of 10 defendants in ‘newborn deaths gang’ trial https://t.co/tjivJD7y0M

— Turkish Minute (@TurkishMinuteTM) December 3, 2024

The scandal is not an isolated incident but part of a broader pattern of exploitation within Turkey’s healthcare system. Fraudulent practices are rampant, ranging from unnecessary surgeries to the misuse of medical supplies.

Dr. Gezer shares an example from his experience: “In one hospital, I observed doctors using substandard orthopedic implants. These implants were of such poor quality that they caused complications, requiring additional surgeries. The hospital pocketed the difference between the cost of the cheap implants and the amount reimbursed by SGK.”

Another common practice involves billing SGK for expensive medical items that are never used. Dr. Gezer recalls: “Angioplasty catheters, which cost hundreds of thousands of lira, were often registered with SGK but set aside. Cheaper alternatives were used on patients, and the expensive ones were sold to private-paying patients.”

Dr. Serim gives additional examples supporting this view.

“A hospital in İstanbul was exposed in the media for visiting villages and mosques and bringing in elderly patients to perform unnecessary procedures, billing the state for the work. Thousands of unnecessary cataract surgeries were performed,” Serim says, adding that another way to extort the SGK is unnecessary implants.

“Implants used in surgeries, such as spinal stabilization, hip replacements and knee replacements: These are surgeries that require expensive materials. I firmly believe that, per capita, Turkey ranks first in the world for the number of spinal titanium screws and other orthopedic instruments used,” Serim says.

City hospitals: A flawed experiment

The construction of city hospitals under the public-private partnership (PPP) model has added another layer of complexity to Turkey’s healthcare system. While these hospitals were touted as a solution to overcrowding and inefficiencies, they have become symbols of wasteful spending and corruption.

City hospitals operate under contracts that guarantee patient volumes, forcing SGK to cover costs even if the hospitals remain underutilized. Dr. Gezer points to the example of Konya, where a new city hospital was built despite the presence of multiple functioning state and university hospitals. “To justify the new facility, they closed an existing hospital and auctioned off its equipment to private affiliates. These hospitals are designed more for profit than patient care,” he says.

In city hospitals, the state pays salaries for healthcare workers, but profits go to the private companies that manage the facilities. This creates a lopsided system where public funds are used to subsidize private profits.

No oversight

One of the most glaring issues in Turkey’s healthcare system is the lack of effective regulatory oversight. The Court of Accounts has repeatedly highlighted fraudulent practices in its audits, including billing for phantom patients, unnecessary procedures and unused medical supplies.

In a 2019 investigation, the Court of Accounts discovered that hospitals had invoiced SGK for 35,000 unused medical items, defrauding the institution of 250 million lira. Despite such findings, there has been little accountability for these practices.

Dr. Serim points to something beyond the weak auditing mechanisms. “Judges, prosecutors and SGK doctors are afraid to act due to the political pressures infiltrating the system. This lack of accountability emboldens hospitals to continue their exploitative practices.”

The current climate of impunity and fear within the Turkish judiciary and its institutions has its roots in years of political centralization and the erosion of democratic norms under the ruling Justice and Development Party (AKP). Major reshuffles in the judiciary after sweeping purges following a 2016 coup attempt have allowed the government to appoint loyalists to key positions in the judiciary and institutions. These changes have favored a system in which decisions are guided by the political agenda rather than legal principles.

The increasing centralization of power has stifled dissent, forcing professionals — including judges, prosecutors and even SGK doctors — to work in an environment where questioning those allied with the government can lead to demotion, dismissal or even prosecution. Over the years, a culture of fear has developed that discourages authorities from taking action against perpetrators with political or financial influence. This has not only crippled the rule of law but has also left vulnerable communities — including women, LGBTQ+ individuals, minorities and workers — without meaningful access to justice as institutions prioritize political survival over accountability and fairness.

The darker side of neonatal care

The newborn deaths gang scandal has also sparked speculation about more sinister motives behind the deaths of infants. Some experts have raised concerns about the potential exploitation of newborns for stem cell harvesting.

Stem cells, particularly those derived from umbilical cord blood, are highly valuable in medical research and treatments. Dr. Gezer raises troubling questions: “Were these infants’ deaths simply due to negligence, or were they exploited for their stem cells? If the latter is true, it represents a horrifying commodification of human life.”

While these claims remain speculative, the broader issue is how financial incentives, as well as a climate of impunity, have corrupted Turkey’s healthcare system, turning patients into commodities.

In the ongoing trial, defendants Fırat Sarı and İlker Gönen, a doctor, could each face sentences of up to 582 years, while defendant Gıyasettin Mert Özdemir, an ambulance driver for the 112 Emergency Call Center, could be sentenced to 589 years in prison if found guilty.

A prison sentence ranging between 10 to 437 years is demanded for “negligent homicide” in connection with the death of the newborns for 18 other suspects, including doctors, nurses and healthcare workers.

The licenses of 10 hospitals alleged to have been involved in the incidents have been revoked following the publication of the indictment’s details in the media, with a total of 19 health institutions deemed to bear responsibility.

The main opposition Republican People’s Party (CHP) sought a parliamentary inquiry into the affair and called for the resignation of Health Minister Kemal Memişoğlu, who stated following the revelation of the scandal that his ministry’s inspections of hospitals will now be carried out “more strictly than ever.”