Lisbon Dermatologist’s Scam Spurs Nationwide Hospital Fraud Crackdown

Whispers of misconduct surrounding a single dermatologist at Lisbon’s Hospital de Santa Maria have rippled far beyond the capital, returning a familiar question to dinner-tables across the country: can Portugal still trust its public health system?

Snapshot

The controversy involves Miguel Alpalhão, a dermatological surgeon who, according to health-inspectorate IGAS, may have obtained €700 000 in irregular payments between 2021 and early 2025. Investigators say the doctor re-coded operations, raised the apparent clinical severity, and in more than 350 instances even keyed in his own surgeries, moves that unlocked extra financial incentives. For Ana Paula Martins, the Minister of Health, episodes such as this one are “isolated yet corrosive,” eroding public confidence, forcing a debate on professional ethics, and accelerating new anti-fraud mechanisms inside the Serviço Nacional de Saúde, SNS.

A trust shaken at Santa Maria

Within Portugal’s largest teaching hospital, colleagues speak quietly of a “perfect storm”: a high-profile specialist, a billing system reliant on case-mix formulas, and a national shortage of dermatologists that left ward managers reluctant to question volume spikes. While the Public Prosecutor weighs possible charges, the Ministry has ordered an internal audit, suspended incentive payments linked to self-validated coding, and barred physicians from auditing their own cases. The news broke only weeks after IGAS published its annual bulletin showing a 3.4 % rise in healthcare complaints during the first half of 2025—fuel for opposition parties that already criticise the government’s stewardship of the SNS.

Government counter-offensive

Determined to seize the narrative, the Cabinet approved a Commission for Combating Fraud led jointly by the Polícia Judiciária and IGAS, with support from Infarmed and the Central Administration of the Health System. The body enjoys a three-year mandate and direct access to hospital accounting platforms. Parallel reforms cap waiting times for oncology and cardiology surgery at 30 days, set a six-month ceiling for non-urgent procedures, and tie individual bonuses inside High-Performance Centres to both productivity and patient-satisfaction metrics. Even the widely praised SIGIC surgical registry is being overhauled to expose anomalies automatically rather than relying on tip-offs from whistle-blowers.

Why the stakes feel higher now

Data from the Health-Regulation Authority reveal that "care quality and patient safety" complaints formed 28.9 % of grievances in inpatient settings last year, overtaking issues of access for the first time since 2019. On the consumer-driven Portal da Queixa, allegations of medical negligence rose 26 % year-on-year. The Order of Physicians likewise processed a record 2 027 disciplinary files in 2023, a surge the bastonário attributes to both a larger workforce and mounting pressure inside hospitals. These statistics feed a perception that the SNS, celebrated at its 1979 birth as a pillar of universalism, now struggles to police itself.

Lessons from abroad—and at home

Patient-safety scholars point out that Portugal already subscribes to the WHO Global Patient Safety Action Plan 2030, yet implementation remains uneven. They advocate mandatory continuing medical education, interoperable electronic health records with hard stops against dubious coding, and a culture in which near misses are reported without fear of retaliation. The national Patient Safety Plan 2021-2026 nods to these ideals, but funding gaps and the ubiquitous reliance on external "service providers"—the so-called tarefeiros—have slowed progress. Ana Paula Martins hints the new anti-fraud unit will also scrutinise outsourcing contracts, arguing that transparency is the best inoculation against both corruption and clinical error.

Public mood and political calculus

For many Portuguese, faith in the SNS is stitched into identity as tightly as fado or pastéis de nata. Opinion polls still rate it among the country’s most valued institutions, yet every high-profile scandal chips away at psychological security: if an apparently routine skin procedure can be mis-billed, what else might go unnoticed? President Marcelo Rebelo de Sousa warns against letting one incident dictate national policy, but concedes that restoring legitimacy now depends on visibly penalising wrongdoing. With elections on the horizon and healthcare ranking second only to the cost-of-living in voter concerns, the government hopes its rapid response will be remembered longer than the dermatologist who set the uproar in motion.