Sat, Jul 24, 2004 - Page 2 News List

Bogus health claims rile bureau

SCAM Reports of funds being pilfered were exaggerated, the insurance bureau said, but the problem remains significant and mostly involves visitors to China

By Wang Hsiao-wen  /  STAFF WRITER

The Bureau of National Health Insurance yesterday disputed media reports that millions of NT dollars had been lost through insurance fraud, saying the amount had been exaggerated.

But the bureau also said that the amount of money and the number of people involved are still under investigation, and that the practice could threaten the viability of the insurance system.

The bureau on Thursday referred 52 suspicious insurance claims by people who supposedly fell ill when traveling to or working in China to the Bureau of Investigation. According to Sheen Mao-ting (沈茂庭), the deputy general manger of the insurance bureau's department of medical affairs, the loss would only amount to NT$500,000 if all cases were proved to be fraudulent.

Insurance bureau figures show that claims by people visiting China accounted for at least 60 percent of the 15,000 claims last year. The bureau has spent over NT$90 million subsidizing those seeking medical care in China.

"It is difficult to verify these cases, since we cannot simply go to [China] to see if there is such a hospital or clinic," Sheen said.

The insurance bureau ordinarily requires applicants to submit their membership credentials, receipts and consultation paperwork within six months for review. When a claim is approved, patients can receive a daily allowance of NT$2,378 for emergency treatment and NT$6,707 for hospital expenses.

"We had hoped to ensure the right of citizens to medical care, even overseas, yet this kind of forgery could cripple our ability to sustain the service," said Liu Chien-hsiang (劉見祥), the bureau's newly appointed director-general.

"We will tighten our procedures when reviewing cases for overseas medical reimbursement," Liu said.

The bureau, however, can only appeal to the public not to commit fraud in the absence of reliable means of verification. Because the alleged fraudulent claims involved facilities outside the bureau's administrative area, it has no authority to inquire into the validity of certification presented by claimants.

"We are not in the position to regulate against malpractice in China. It is highly improbable that we can go out there and find out which swindlers are picking our pockets," Liu said.

According to Article 72 of the National Health Insurance Law (全民健保法), people who present phony certification must pay double the amount of the fee claimed as well as face additional criminal charges.

Liu said that his bureau needed to cooperate more closely with the Ministry of Justice and the Mainland Affairs Council to crack down on insurance fraud.

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