Sat, May 29, 2010 - Page 2 News List

DOH to clamp down on health insurance fraud

By Shelley Huang  /  STAFF REPORTER

Following several publicized cases of National Health Insurance (NHI) fraud, the Department of Health (DOH) said it was mulling an increase in penalties for medical institutions that seek to defraud the insurance system.

The department has been accused of not implementing measures to prevent hospitals, doctors and fraud rings from defrauding the system and contributing to the health insurance fund’s large deficit.

Last month, the DOH fined Kaohsiung Medical University Chung-ho Memorial Hospital NT$150 million (US$5 million) for several counts of malpractice, including medical insurance fraud and the removal of healthy organs.

In 2006, a former gynecologist at the hospital, surnamed Hsu (?, allegedly performed surgeries on healthy patients, claiming more than NT$500,000 in reimbursements from the Bureau of National Health Insurance. He also gave patients chemotherapy to help them obtain tens of millions of dollars in insurance payouts.

The department said it was considering new penalties for hospitals that aid patients in defrauding the insurance system by deducting a compensation payment from the hospital 10 times the value of the original fraudulent claim. Medical institutions that exaggerate expense reporting or file multiple expense reports are also liable to have their NHI contracts suspended for one to three months, the DOH said.

The DOH said that hospitals and clinics that have had their NHI contracts suspended would also be unable to get around the law by changing their names because officials would focus on registered addresses.

The DOH is also considering an increase in the proportion of hospital beds reserved for people covered by the NHI from the current 65 percent to 75 percent in all public hospitals, as stipulated in the National Health Insurance Act (全民健康保險法). Private hospitals may be asked to increase the number to 60 percent from the current level of 50 percent.

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