Taipei City Hospital has been ordered to repay NT$55 million (US$1.8 million) in National Health Insurance program subsidies for underreporting the number of patients it treated to meet a central government goal of diverting 2 percent of patients at major hospitals to smaller facilities.
The National Health Insurance Administration (NHIA) said that it found about 32,000 “irregular” declarations made by the hospital between January and March.
In that period, the hospital filed 569,000 declarations, meeting the standard for the policy, implemented in July last year, to reduce outpatient visits at large hospitals by 2 percent, NHIA Taipei division head Lin Lee-chin (林麗瑾) said.
Photo: Tsai Ya-hua, Taipei Times
However, big data analysis found irregularities in about 32,000 of those declarations, mostly because diagnostic fees were listed as NT$0, despite there being records of copayments by patients, she said.
Hospital visits in which the diagnostic fee is NT$0 can be excluded from calculations of visits for the policy, she added.
In the past, the hospital filed about 10,000 declarations per quarter in which the diagnostic fee was NT$0, Lin said.
When the NHIA asked the hospital about the discrepancies, the hospital claimed that those declarations were due to “integrated” outpatient appointments or return visits for medical examinations, she said.
However, after an investigation into the matter, the NHIA decided to include the declarations in which diagnostic fees were NT$0 into the calculations of visits included in the policy, resulting in the hospital no longer meeting the goal of reducing visits by 2 percent, Lin said.
As such, the NHIA would require the hospital to repay the NT$55 million in subsidies, she added.
If the increase in the number of such declarations was reasonable, the agency would have given the hospital the benefit of the doubt, NHIA Director-General Lee Po-chang (李伯璋) said.
However, the number of such declarations filed by the hospital was “ridiculous,” he said.
Besides Taipei City Hospital, similar situations have occurred with about 10 other hospitals, he added.
The agency has written letters to the heads of those hospitals to remind them to pay attention to the issue and make adjustments, Lee said.
However, hospitals that fail to reduce outpatient visits would not be suspended from the National Health Insurance program, he said.
Additional reporting by CNA
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