Hospital accused of over-claiming subsidies

The Bureau of National Health Insurance (健保局) yesterday said that Chang Gung Memorial Hospital (長庚醫院) in Linkou had padded its claims for subsidies by more than NT$8 million since 1997.

The Bureau said that the hospital's medical imaging department had over-claimed for expenditure on the computerized tomography (CT) scan and some magnetic resonance imaging (MRI) scans.

The hospital will appeal to the bureau to not suspend subsidy payments to the department for three months, a punishment that is within the bureau's power. Chang Gung would be the first medical center in Taiwan to face such a punishment. The hospital has been ordered to pay the NT$8 million back to the health insurance bureau, along with a penalty of over NT$16 million.

The hospital has not yet decided whether it will ask the patients receiving the department's services to cover the full cost of treatment if the suspension takes effect as scheduled in June. About 10,000 patients are using the department's imaging services each month.

Currently Taiwan residents enrolled in the national health insurance project -- which is administered by the national health bureau -- need only pay a portion of the cost of medical services. The balance is covered by the health insurance bureau.

Chuang Yi-chou (莊逸洲), the director of administration at Chung Gung Hospital, said the hospital would return the over-claimed money to the bureau but he did not feel that a punishment of suspended subsidies is reasonable. He said that the over-claiming had resulted from a misunderstanding about how doctors should apply for subsidies for certain medical imaging services.

"Dr. Wang, who was involved in the incident, did not over-claim subsidies on purpose. He used to practice medicine in the US and has applied for subsidies for medical scan services according to the US system," Chuang said.

Chuang further explained that sometimes doctors use 3D CT scans for certain sufferers of particular illnesses for more useful imaging than the traditional and cheaper CT of only two dimensions.

Chuang said Wang made the mistake because the relevant instructions never clearly stated how a doctor should apply for subsidies from the health insurance bureau to cover the 3D CT scans. Wang therefore adopted the US system, which allows the doctor to claim for a subsidy equivalent to that for two CT scans for one 3D scan.

The health insurance bureau had said there were two doctors involved in the over-claiming.