Clipping Board » Medical Affairs and Administration ─ Medical system, pharmaceuticals, and medical community-related reports
Release Date: 04.13.2010
The case of "Physician Swaps Cancer Tissue to Fraudulently Claim Medical Expenses from the NHI Bureau and Insurance Payouts from Insurance Companies" involving Kaohsiung Medical University Chung-Ho Memorial Hospital was investigated by the NHI Bureau of the Department of Health in collaboration with the Southern Criminal Investigation Bureau’s Crime-Fighting Center. It was discovered that the hospital’s gynecology department chief physician, Dr. Hsu ○-cheng, under the instigation of insurance fraud broker Mr. Lee ○-chang, issued false diagnostic certificates to facilitate policyholders in applying for catastrophic illness benefits and private insurance claims. Simultaneously, the physician also submitted claims to the NHI Bureau for cancer surgeries, chemotherapy, and other medical expenses related to these policyholders.
On December 29, 2009, the NHI Bureau issued a notice in accordance with the Contracted Medical Care Institutions Agreement and Management Regulations of the National Health Insurance, imposing a one-year suspension of contracted medical services (including outpatient and inpatient services) for the gynecology department of Kaohsiung Medical University Chung-Ho Memorial Hospital. Although the hospital filed an appeal, on April 9, 2010, the National Health Insurance Dispute Mediation Committee ruled to "reject the appeal." The Department of Health also required the hospital to continue providing gynecological services during the suspension period; otherwise, its medical center accreditation would be revoked.
Regarding the illegal actions of Dr. Hsu ○-cheng, the Tainan District Prosecutors Office has already filed charges, and the case is currently under judicial review. Similar illegal cases involving multiple physicians from other hospitals are also under investigation. Once the investigations confirm the violations, the Department of Health will impose the strictest penalty of revoking the medical licenses of the involved physicians.
Source: http:/ / www. nhi. gov. tw/ inform……ws_ID=857& menu=9& Menu_id=544
Doctor Swaps Cancer Tissue to Defraud Health Insurance
The case of "Physician Swaps Cancer Tissue to Fraudulently Claim Medical Expenses from the NHI Bureau and Insurance Payouts from Insurance Companies" involving Kaohsiung Medical University Chung-Ho Memorial Hospital was investigated by the NHI Bureau of the Department of Health in collaboration with the Southern Criminal Investigation Bureau’s Crime-Fighting Center. It was discovered that the hospital’s gynecology department chief physician, Dr. Hsu ○-cheng, under the instigation of insurance fraud broker Mr. Lee ○-chang, issued false diagnostic certificates to facilitate policyholders in applying for catastrophic illness benefits and private insurance claims. Simultaneously, the physician also submitted claims to the NHI Bureau for cancer surgeries, chemotherapy, and other medical expenses related to these policyholders.
On December 29, 2009, the NHI Bureau issued a notice in accordance with the Contracted Medical Care Institutions Agreement and Management Regulations of the National Health Insurance, imposing a one-year suspension of contracted medical services (including outpatient and inpatient services) for the gynecology department of Kaohsiung Medical University Chung-Ho Memorial Hospital. Although the hospital filed an appeal, on April 9, 2010, the National Health Insurance Dispute Mediation Committee ruled to "reject the appeal." The Department of Health also required the hospital to continue providing gynecological services during the suspension period; otherwise, its medical center accreditation would be revoked.
Regarding the illegal actions of Dr. Hsu ○-cheng, the Tainan District Prosecutors Office has already filed charges, and the case is currently under judicial review. Similar illegal cases involving multiple physicians from other hospitals are also under investigation. Once the investigations confirm the violations, the Department of Health will impose the strictest penalty of revoking the medical licenses of the involved physicians.
Source: http:/ / www. nhi. gov. tw/ inform……ws_ID=857& menu=9& Menu_id=544