Insurance scams to be investigated

Review of hospitals, pharmacies will be carried out nationwide

China has ordered a review of hospitals and pharmacies nationwide looking for possible health insurance scams, an official said at a news conference on Wednesday, a week after China Central Television exposed two suspicious cases in Northeast China.

The new review follows a national inspection in September looking for fraudulent practices in the sector, according to Huang Huabo, an official with the newly created National Health Care Security Administration.

“The medical insurance fund is lifesaving money for the public. Ensuring its security is significant for people’s livelihoods, and it’s also an important political task,” he said.

Two hospitals in Shenyang, Liaoning province, were accused of hiring people who were covered by the country’s basic health insurance system and hospitalized them using fake medical records to claim insurance money from the government, CCTV reported last week.

As of Monday, 37 suspects had been detained by police in Shenyang, and 19.9 million yuan ($2.87 million) of insurance money had been frozen, the broadcaster said on Wednesday.

China began to create nationwide basic medical insurance that covers urban and rural residents in 2007, and coverage expanded over time. More than 1.35 billion people are covered by the system, according to the National Health Commission, about 95 percent of China’s population.

Insured residents pay into the fund on a regular basis, alongside the State and employers, and they can have a certain percentage of their medical bills reimbursed.

But during the earlier inspection, a number of hospitals were found to have defrauded the insurance fund. According to the administration, 761 hospitals, clinics and pharmacies in Chuangchun, Jilin province, were disciplined during that inspection, and government agencies refused to reimburse more than 10 million yuan ($1.44 million) of insurance claims.