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[Reporter Yang Guowen / Taipei Report]
The National Health Insurance Administration (NHIA) sets a monthly cap on the number of patients a physician can see, with fees decreasing for visits exceeding the limit. Seven clinics in Taipei and Taoyuan County were found to have "allocated" patients treated by other doctors to 25 elderly physicians who did not actually see them, fraudulently claiming over NT$133 million in medical fees from the NHIA. Yesterday, the Taipei High Administrative Court ruled against the seven clinics, including De Jia Clinic, stating that the NHIA was legally justified in recovering the overpaid fees. The case can still be appealed.
The head physician of De Jia Clinic, surnamed Hong, was not at home yesterday. His family stated they would appeal, explaining that Hong was only a nominal head and that the actual owner was another investor. They added that legal matters would be left to the court's judgment.
The NHIA investigation revealed that from January 2004 to April 2007, the seven clinics, including De Jia and De Ming, used the licenses of 25 elderly physicians, such as one surnamed Liu, through a third-party company, Ocean International. They falsely reported patient visits under these elderly physicians' names to claim fees from the NHIA.
According to NHIA statistics, each clinic fraudulently claimed between NT$7.09 million and NT$30.16 million, totaling NT$133.68 million. The NHIA demanded the clinics return the overpaid amounts in full.
The clinics argued that although the elderly physicians did not see patients alone, they participated in "joint consultations" or "collaborative visits," a common practice in the medical field, and that this did not constitute "license borrowing." They claimed the NHIA had no grounds to deny payment.
The Taipei High Administrative Court noted that as general clinics, there was no need for "joint consultations." It also found that the elderly physicians' reported visit numbers matched those of other doctors, yet they only received a fixed monthly salary of NT$30,000 and a NT$2,000 travel allowance per session—far less than the NT$100,000 salaries of other physicians. The court thus concluded that the elderly physicians did not actually see patients.
Source: http:/ / www. libertytimes. com. ……0/ new/ mar/ 10/ today- life8. htm
Old Doctors Used as Fronts: 7 Clinics Fraudulently Claimed $13M from Health Insurance
The National Health Insurance Administration (NHIA) sets a monthly cap on the number of patients a physician can see, with fees decreasing for visits exceeding the limit. Seven clinics in Taipei and Taoyuan County were found to have "allocated" patients treated by other doctors to 25 elderly physicians who did not actually see them, fraudulently claiming over NT$133 million in medical fees from the NHIA. Yesterday, the Taipei High Administrative Court ruled against the seven clinics, including De Jia Clinic, stating that the NHIA was legally justified in recovering the overpaid fees. The case can still be appealed.
The head physician of De Jia Clinic, surnamed Hong, was not at home yesterday. His family stated they would appeal, explaining that Hong was only a nominal head and that the actual owner was another investor. They added that legal matters would be left to the court's judgment.
The NHIA investigation revealed that from January 2004 to April 2007, the seven clinics, including De Jia and De Ming, used the licenses of 25 elderly physicians, such as one surnamed Liu, through a third-party company, Ocean International. They falsely reported patient visits under these elderly physicians' names to claim fees from the NHIA.
According to NHIA statistics, each clinic fraudulently claimed between NT$7.09 million and NT$30.16 million, totaling NT$133.68 million. The NHIA demanded the clinics return the overpaid amounts in full.
The clinics argued that although the elderly physicians did not see patients alone, they participated in "joint consultations" or "collaborative visits," a common practice in the medical field, and that this did not constitute "license borrowing." They claimed the NHIA had no grounds to deny payment.
The Taipei High Administrative Court noted that as general clinics, there was no need for "joint consultations." It also found that the elderly physicians' reported visit numbers matched those of other doctors, yet they only received a fixed monthly salary of NT$30,000 and a NT$2,000 travel allowance per session—far less than the NT$100,000 salaries of other physicians. The court thus concluded that the elderly physicians did not actually see patients.
Source: http:/ / www. libertytimes. com. ……0/ new/ mar/ 10/ today- life8. htm