About 80 percent of reimbursements for advanced medical expenses in foreign countries between 2014 and last year were for procedures in China, National Health Insurance Administration (NHIA) statistics showed.
NHIA Deputy Director-General Tsai Shu-ling (蔡淑鈴) said that the agency has reimbursed NT$201.41 million (US$6.7 million) for advanced medical expenses last year, with 63 percent of the cases in China.
Cases in Japan accounted for 7 percent, whereas those in Thailand and Vietnam each accounted for 5 percent.
The amount the NHIA has reimbursed for overseas advanced medical expenses has gradually decreased from NT$360 million in 2017 and NT$260 million in 2018 to NT$201.41 million last year, she said.
Meanwhile, 19 percent of reimbursements for outpatient care services in other countries were for acute upper respiratory tract infections, Tsai said, adding that it was followed by kidney failure and acute bronchitis, which accounted for 15 percent and 8 percent respectively.
Regarding reimbursements for emergency care services, 11 percent involved accidental injuries, 7 percent were for noninfectious gastroenteritis and colitis, and 6 percent were for acute bronchitis, she said.
For hospitalization reimbursements, 10 percent were for pneumonia, 6 percent for cerebral hemorrhage and 6 percent for accidental injuries.
“We have a database of these reimbursements, which includes data about the doctors, clinics and illnesses and other key information, which we can use when we closely examine any case, hospital, clinic and insured person,” Tsai said.
She added that this has helped the agency gradually lower overseas advanced medical expenses.
The NHIA has taken other measures to reduce overseas medical reimbursements, including by connecting the database with the immigration system and ensuring that it would only reimburse medical expenses for unexpected injuries.
Under Article 81 of the National Health Insurance Act (全民健保法), a person applying for reimbursements or medical expense claims through improper conduct, or by making a false certification, report or misrepresentation would be fined between two and 20 times the benefits or medical expenses received. If a criminal offense is involved, they would also be referred to the courts.
In related news, an investigation by Control Yuan member Chang Wu-shou (張武修) has found that a doctor in China produced false certificates of diagnosis for 54 people, which resulted in them claiming NT$260,000 in reimbursements.
In 2012, the Criminal Investigation Bureau investigated 28 Taiwanese tourists in Cambodia who used fake certificates of hospitalization to claim NT$410,000 in reimbursements, Chang said.
The fraud occurred with the collusion of a travel agency, which organized the tour, and an insurance company, Chang added.
The Control Yuan said it has asked the NHIA to adjust the way it manages reimbursement for advanced medical expenses in China.
Additional reporting by Hsieh Chun-ling
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