Fraud cases involving National Health Insurance (NHI) payments hit a record NT$221.19 million (US$6.92 million) last year, the National Health Insurance Administration (NHIA) said yesterday.
The agency said that it boosted its investigation efforts last year amid an increase in collusion between healthcare practitioners and the public using false medical certificates or medical records to declare payments or make insurance claims.
NHIA senior official Kao Shih-hao (高世豪) said that the false claims for NHI payments from medical facilities increased from NT$68.22 million in 2013 to NT$83.16 million in 2014 and nearly tripled last year.
Photo: Lin Hui-chin, Taipei Times
Among the 2,285 medical facilities it investigated in the past three years, 1,108 were found to have breached the regulations, Kao said.
The agency said that an otolaryngology clinic in China’s Guangdong Province operated by Taiwanese has a medical license in China, but not in Taiwan.
The clinic provided more than 9,000 medical certificates to more than 2,400 Taiwanese, which were used to claim reimbursements for overseas medical expenses in the past two years, the agency said.
The majority of those claims involved cases of high fever, an upper respiratory infection or throat inflammation, with reimbursements reaching about NT$12.59 million, it said.
However, investigators said that some of the claims were made by people who were in Taiwan at the time the treatment was reported to have taken place abroad.
The agency said that serious fraud was discovered involving Min-Sheng General Hospital deputy superintendent Lee Wei-jie (李威傑), who is well known for performing weight-reduction surgery, and Lee General Hospital deputy superintendent Wang Ying-fan (王芳英), former head of the orthopedic department at Taichung Armed Forces General Hospital.
NHIA Director-General Lee Po-chang (李伯璋) said they investigated Lee Wei-jie over accusations that he falsely reported NHI-covered peptic ulcer surgeries when he performed self-paid bariatric surgeries.
The activity involved claims for about NT$50 million in reimbursements from 2010 to this year, Lee Po-chang said.
About 20,000 peptic ulcer cases are reported each year, while only about 2,300 require surgery, but the cases reported by Lee Wei-jie were about one-quarter of the total he received, Lee Po-chang said.
He said once administrative procedures are completed, the agency will cancel its NHI contract with Min-Sheng General Hospital for a year or impose a fine of at least NT$100 million on the hospital.
Most healthcare practitioners in Taiwan are disciplined, but a few unethical people have been boldly committing insurance fraud, Lee Po-chang said.
He urged healthcare practitioners to abide by the regulations and called on the public to cherish the nation’s NHI resources.
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