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Update Date: 2010/08/07 04:11 [Reporter Ruan Yiyu / Yuanlin Report]
Changhua County’s Yuanlin Xiehe Hospital colluded with 12 elderly care centers in the county, providing nursing supplies in exchange for the health insurance cards of elderly residents at these centers. The hospital then used the health insurance cards like "credit cards," fraudulently "swiping" them to claim nearly NT$40 million from the National Health Insurance Administration (NHIA). On the 6th, the prosecution concluded the investigation. Considering practical benefits, all 27 individuals involved were allowed to pay hefty fines in exchange for deferred prosecution. Among them, the hospital was required to pay nearly NT$70 million, and four doctors were each mandated to perform 240 hours of free medical services.
Yuanlin Xiehe Hospital Involved in Illegal Activities
The deferred prosecution statement revealed that Yang Maochang, Yin Jinjian, Xiao Ruipeng, and Liu Jianhua jointly operated Xiehe Hospital, with Yin and Xiao also serving as resident physicians. Additionally, the hospital employed Cai Bozong, Chen Hongzhang, and Guo Xiquan as doctors. Among them, the 71-year-old Cai Bozong, though nominally the hospital director, did not actually see patients.
4 Doctors to Perform 240 Hours of Free Medical Services Each
The deferred prosecution statement noted that from 2004 to 2009, the hospital fraudulently claimed NHIA reimbursements by providing elderly care centers with medications and medical supplies in exchange for the centers handing over the health insurance cards of elderly residents. The hospital then fabricated medical records to claim reimbursements. Additionally, the hospital exploited opportunities such as foreign workers receiving nutrient injections to create false medical records, issued prescriptions for medications never dispensed, and had other doctors conduct consultations under the name of the nominal director, Cai Bozong. Using these falsified medical records, the hospital fraudulently claimed over NT$33 million from the NHIA.
The prosecution stated that the hospital’s responsible parties, doctors, and elderly care center operators all admitted to their crimes. Apart from repaying the NT$33 million in fraudulent claims, the hospital voluntarily returned over NT$5.9 million in unauthorized claims for medical services provided at the care centers, demonstrating clear remorse.
Moreover, if deferred prosecution was granted, the NHIA could separately impose an additional fine of over NT$17.5 million on the hospital. The prosecution also ruled that the hospital’s responsible parties and doctors must jointly pay NT$10 million to the national treasury. The four doctors involved were each required to perform 240 hours of free medical services. The hospital’s responsible parties and external doctors—seven individuals in total—were given a three-year deferred prosecution period.
On the other hand, 20 other implicated hospital employees and elderly care center operators were each given deferred prosecution terms of one to three years and required to pay fines ranging from NT$50,000 to NT$300,000.
Source: http:/ / tw. news. yahoo. com/ art……url/ d/ a/ 100807/ 78/ 2an8h. html
Hospital Pays 70M for Deferred Prosecution in 38.9M Insurance Fraud Case
Changhua County’s Yuanlin Xiehe Hospital colluded with 12 elderly care centers in the county, providing nursing supplies in exchange for the health insurance cards of elderly residents at these centers. The hospital then used the health insurance cards like "credit cards," fraudulently "swiping" them to claim nearly NT$40 million from the National Health Insurance Administration (NHIA). On the 6th, the prosecution concluded the investigation. Considering practical benefits, all 27 individuals involved were allowed to pay hefty fines in exchange for deferred prosecution. Among them, the hospital was required to pay nearly NT$70 million, and four doctors were each mandated to perform 240 hours of free medical services.
Yuanlin Xiehe Hospital Involved in Illegal Activities
The deferred prosecution statement revealed that Yang Maochang, Yin Jinjian, Xiao Ruipeng, and Liu Jianhua jointly operated Xiehe Hospital, with Yin and Xiao also serving as resident physicians. Additionally, the hospital employed Cai Bozong, Chen Hongzhang, and Guo Xiquan as doctors. Among them, the 71-year-old Cai Bozong, though nominally the hospital director, did not actually see patients.
4 Doctors to Perform 240 Hours of Free Medical Services Each
The deferred prosecution statement noted that from 2004 to 2009, the hospital fraudulently claimed NHIA reimbursements by providing elderly care centers with medications and medical supplies in exchange for the centers handing over the health insurance cards of elderly residents. The hospital then fabricated medical records to claim reimbursements. Additionally, the hospital exploited opportunities such as foreign workers receiving nutrient injections to create false medical records, issued prescriptions for medications never dispensed, and had other doctors conduct consultations under the name of the nominal director, Cai Bozong. Using these falsified medical records, the hospital fraudulently claimed over NT$33 million from the NHIA.
The prosecution stated that the hospital’s responsible parties, doctors, and elderly care center operators all admitted to their crimes. Apart from repaying the NT$33 million in fraudulent claims, the hospital voluntarily returned over NT$5.9 million in unauthorized claims for medical services provided at the care centers, demonstrating clear remorse.
Moreover, if deferred prosecution was granted, the NHIA could separately impose an additional fine of over NT$17.5 million on the hospital. The prosecution also ruled that the hospital’s responsible parties and doctors must jointly pay NT$10 million to the national treasury. The four doctors involved were each required to perform 240 hours of free medical services. The hospital’s responsible parties and external doctors—seven individuals in total—were given a three-year deferred prosecution period.
On the other hand, 20 other implicated hospital employees and elderly care center operators were each given deferred prosecution terms of one to three years and required to pay fines ranging from NT$50,000 to NT$300,000.
Source: http:/ / tw. news. yahoo. com/ art……url/ d/ a/ 100807/ 78/ 2an8h. html