The National Health Insurance Administration (NHIA) yesterday warned the public that it would seek to recoup National Health Insurance payments and damages in cases of proven insurance fraud, citing as an example women who had claimed reimbursements for supposedly needing emergency cesarean sections while traveling in the US.
Since 2016, the NHIA has tightened its review on claims for NHI reimbursements of medical expenses in other nations, especially in cases of caesarean sections in the US, so the approval rate has fallen from 63 percent in 2016 to 23 percent in 2018, NHIA official Tung Yu-yun (董玉芸) said.
The Criminal Investigation Bureau in 2016 opened an investigation into allegations that a postpartum care service agency had organized “medical tour” packages for Taiwanese women who wanted to give birth in the US, telling them how to claim US citizenship for their children and how to obtain reimbursement — with fake diagnosis certificates — from the NHIA and the insurance companies that provided their travel insurance.
Photo: Lin Hui-chin, Taipei Times
The New Taipei District Prosecutors’ Office on July 26, 2017, indicted agency owner Liu Chao-hsun (柳昭薰) and an employee surnamed Lee (李) on charges of fraud, forgery, inciting others to commit a criminal offense and related charges, and also indicted several women who participated in the scheme.
A scam was first suspected by an insurance company after it noticed the similarity in claims from women who had undergone caesarean sections while in the US and it reported its suspicions to the Institute of Financial Law and Crime Prevention.
Liu launched a Web site in 2013, providing information on how pregnant women could pretend to become ill while in the US and need an emergency caesareans for placenta previa, which occurs when the placenta covers part or all of a woman’s cervix, Tung said.
A fake diagnosis certificate for placenta previa was provided by a California clinic so that Liu’s clients could claim National Health Insurance reimbursement and file claims on the travel insurance policies when they returned to Taiwan, she said.
Clients were charged about NT$400,000 (US$13,369 at the current exchange rate) for the service, and they could claim NHI reimbursement for about NT$25,000 from the NHIA and an average of NT$300,000 from insurance companies, Tung said.
Liu was sentenced to one year in prison, seven clients were sentenced to terms of differing lengths, while 17 others were granted deferred prosecution after they admitted to having participated in the scheme and promised to return the insurance money and pay a fine of NT$100,000.
Thirty-four of Liu’s clients obtained a total of about NT$7 million, including about NT$650,000 in NHI reimbursements, Tung said, adding that the NHIA would seek NT$25,000 in reimbursement as well as a NT$50,000 fine from each of the clients.
Additional reporting by staff writer
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