Insurance scam puts hospital in firing line

Doctors and administrators at a major hospital in Hefei, Anhui province, are facing punishment after investigators discovered widespread medical insurance fraud.

Employees at the Third Affiliated Hospital of Anhui University of Chinese Medicine have been forging hospitalization expenses for “familiar” patients to bilk money from the national health insurance fund, Xinhua News Agency reported.

Evidence of the violations was uncovered by an investigation team comprising officials responsible for social security, health and traditional Chinese medicine.

Provincial authorities have pledged to bring the involved institutions and individuals to justice as quickly as possible, Xinhua reported.

Similar cases of medical insurance fraud in the past have resulted in doctors losing their license to practice as well as hospitals being removed from China’s health insurance program, which can drastically affect the number of patients they receive.

On Jan 18, Xinhua reported that many doctors in the hospital forged examinations, diagnoses and hospitalization records using patients’ health insurance cards, often in cooperation with the patients.

In a typical example, a patient would visit the hospital for a common disease that requires only a simple medicinal remedy. The doctors would hospitalize the patient “on the record” but actually they would be discharged to return home.

In this way, the hospital can get money from the national health insurance fund for the hospitalization expenses without any actual services or overnight stays involved. In return, the doctor writes up prescriptions for whatever medicine the patient requests.

According to regulations, 90 percent of drug expenses incurred during hospitalization will be covered by the insurance fund.

Patients can ask for drugs for other family members at just 10 percent of market prices, or even sell leftover pharmaceuticals to middlemen who then flip them to the uninsured for a healthy profit.

Many patients leave their health insurance cards with doctors who will swipe the cards at regular intervals to renew the patient’s bogus hospitalization. The doctors also give cash to some “key” patients.

The government will strengthen supervision over the use of healthcare insurance and use digital methods to monitor treatment and avoid illegal collusion between patients and doctors, according to the Xinhua report.