A traditional Chinese medicine clinic in Changhua County has been suspended from the National Health Insurance (NHI) system for up to six years for falsifying patient records, the Bureau of National Health Insurance said.
It was the second offense by the clinic, which had previously been suspended for three months in 2007 for defrauding the system, the bureau said.
Last month, the clinic fleeced the system of more than NT$100,000 by fabricating patient records — an offense that is punishable by a one-year suspension, the bureau said.
Since the clinic is a repeat offender, it faces an additional five-year contract suspension, the bureau said, citing the Regulations Governing Contracting and Management of National Health Insurance Medical Care Institutions (全民健康保險醫事服務機構特約及管理辦法), which state that “medical care institutions or responsible medical personnel applying to be a contractor [for the NHI system] will be disqualified for five years [if] the franchise contract is terminated for the second time within five years from the last time the previous contract was terminated.”
The decision was the most severe penalty meted out by the bureau since the health insurance program was launched.
Before amendments to the regulations were passed this year, medical facilities that failed to abide by the rules only faced up to one year’s suspension at the most.
While the suspension period has been extended to five years, it is just half of the 10 years that was in the original draft proposal.