Several hospitals have falsified or inflated the number of surgeries they performed using the Da Vinci robotic surgical system, the National Health Insurance Administration (NHIA) said yesterday, calling into question 7,810 insurance claims with a combined cost of more than NT$350 million (US$11.33 million).
Although the system is popular due to its advantages, such as reduced pain and discomfort, less blood loss and scarring, and faster recovery time, the procedure is not covered the National Heath Insurance (NHI) system, and patients have to pay for it out of pocket.
The only exception is that, starting in 2017, hospitals using the system for prostate gland removal can declare it as NHI-covered laparoscopic surgery to reduce the financial burden on patients.
However, data provided by Intuitive Surgical, which makes the robotic system, showed that the number of surgeries performed using the system in Taiwan did not match the declared numbers, NHIA Deputy Director-General Tsai Shu-ling (蔡淑鈴) said, adding that an analysis by the agency found abnormal declarations.
A total of 13,903 surgeries were performed using the system from 2015 to February, according to hospitals’ declarations to the NHIA.
However, the agency found that some hospitals charged patients NT$180,000 to NT$200,000 while also applying to the NHIA for reimbursement for types of surgery covered by the NHI.
“The cost for Da Vinci surgery operations is paid out of pocket, so hospitals should not file repeat reports” to receive NHI reimbursements, Tsai said.
Of the nation’s 19 medical centers, 12 performed more than 200 surgeries per year using the system, the NHIA said.
Five of the centers have allegedly made abnormal declarations accounting for more than 20 percent of all the surgeries they performed in a year, it said, adding that 41 percent of the abnormal cases were filed by urology and gynecology departments.
Taipei Medical University Hospital topped the list with 2,144 abnormal declarations, followed by China Medical University Hospital, Linkou Chang Gung Memorial Hospital, Taipei Medical University’s Shuang Ho Hospital and National Taiwan University Hospital, the NHIA said.
The agency respects the medical profession, so it on Friday gave the hospitals one week to rectify the abnormal cases, Tsai said, adding that those who admit to wrongdoing would only be asked to return the NHI payments.
However, if investigations found that the hospitals intentionally declared false or inflated figures, they could be fined 10 times the NHI-covered amount and suspended from the NHI system for up to three months, or up to one year in serious cases, she said.
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