Clipping Board » Medical Affairs and Administration ─ Medical system, pharmaceuticals, and medical community-related reports
Update Date: 2008/07/28 04:09
[Reporter Wang Junzhong / Tainan Report]
The Tainan District Prosecutors Office has investigated multiple cases of fraudulent claims from the National Health Insurance (NHI), involving various schemes such as "fake hospitalizations, inflated drug prices, front-door pharmacies, AB version prescriptions, fake medical treatments for real beauty services, and unauthorized swiping of NHI cards of non-hospitalized citizens at contracted care centers." Some greedy medical professionals have embezzled tens of billions of NT dollars from the NHI!
In October 2005, Tainan prosecutors and police launched the first wave of investigations into insurance fraud, uncovering a fraud ring involving over 20 members of the Wen Zongming family. They colluded with hospitals such as Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung Lin Jinxing Hospital, Kaohsiung Yongren Hospital, Kaohsiung Taisun Hospital, and Tainan Fuqiang Hospital to fraudulently claim NHI and private medical insurance under the guise of fake hospitalizations. Prosecutors estimated that these hospitals had fraudulently obtained at least NT$340 million in NHI hospitalization payments from 1999 until their discovery.
In early May 2006, the Tainan prosecutors' task force investigated cases of drug suppliers inflating drug prices. They found that suppliers colluded with major domestic hospitals to report higher drug prices to the NHI Bureau while purchasing drugs at lower prices, fraudulently claiming several times the actual drug costs. Prosecutors initially estimated the fraud to amount to NT$40-50 billion.
In mid-May 2006, Tainan prosecutors targeted "front-door pharmacies" associated with clinics, which were suspected of colluding with clinics to fraudulently claim dispensing fees and prescription release fees. Prosecutors offered non-prosecution or deferred prosecution to involved doctors and pharmacists, requiring them to "confess" and return the fraudulently claimed fees from January to April 2006 within one and a half months.
Overreporting and Unauthorized Swiping: The Public Pays the Price
In October 2006, Tainan prosecutors discovered that Tainan De'an Clinic's handwritten prescriptions (Version A) given to patients often did not match the computer records (Version B) submitted to the NHI Bureau for reimbursement. The clinic was suspected of overreporting to fraudulently claim NHI funds. Prosecutors learned from former high-ranking officials of the Department of Health that many clinic doctors nationwide engaged in similar fraud, embezzling NT$10-20 billion annually from the NHI.
On April 20, 2008, Tainan Anping Clinic was also found to have fraudulently swiped patients' NHI cards and colluded with contracted care and nursing centers to swipe NHI cards of non-hospitalized citizens, fraudulently claiming NHI funds. Prosecutors estimated that the clinic had illegally profited over NT$13.75 million in more than three years. Prosecutors strongly suspect that other care, nursing, rehabilitation, and dialysis centers may have similar fraudulent practices and will conduct a comprehensive investigation.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080728/ 78/ 11m. html
"Medical Fraudsters" Scam Billions from Health Insurance
[Reporter Wang Junzhong / Tainan Report]
The Tainan District Prosecutors Office has investigated multiple cases of fraudulent claims from the National Health Insurance (NHI), involving various schemes such as "fake hospitalizations, inflated drug prices, front-door pharmacies, AB version prescriptions, fake medical treatments for real beauty services, and unauthorized swiping of NHI cards of non-hospitalized citizens at contracted care centers." Some greedy medical professionals have embezzled tens of billions of NT dollars from the NHI!
In October 2005, Tainan prosecutors and police launched the first wave of investigations into insurance fraud, uncovering a fraud ring involving over 20 members of the Wen Zongming family. They colluded with hospitals such as Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung Lin Jinxing Hospital, Kaohsiung Yongren Hospital, Kaohsiung Taisun Hospital, and Tainan Fuqiang Hospital to fraudulently claim NHI and private medical insurance under the guise of fake hospitalizations. Prosecutors estimated that these hospitals had fraudulently obtained at least NT$340 million in NHI hospitalization payments from 1999 until their discovery.
In early May 2006, the Tainan prosecutors' task force investigated cases of drug suppliers inflating drug prices. They found that suppliers colluded with major domestic hospitals to report higher drug prices to the NHI Bureau while purchasing drugs at lower prices, fraudulently claiming several times the actual drug costs. Prosecutors initially estimated the fraud to amount to NT$40-50 billion.
In mid-May 2006, Tainan prosecutors targeted "front-door pharmacies" associated with clinics, which were suspected of colluding with clinics to fraudulently claim dispensing fees and prescription release fees. Prosecutors offered non-prosecution or deferred prosecution to involved doctors and pharmacists, requiring them to "confess" and return the fraudulently claimed fees from January to April 2006 within one and a half months.
Overreporting and Unauthorized Swiping: The Public Pays the Price
In October 2006, Tainan prosecutors discovered that Tainan De'an Clinic's handwritten prescriptions (Version A) given to patients often did not match the computer records (Version B) submitted to the NHI Bureau for reimbursement. The clinic was suspected of overreporting to fraudulently claim NHI funds. Prosecutors learned from former high-ranking officials of the Department of Health that many clinic doctors nationwide engaged in similar fraud, embezzling NT$10-20 billion annually from the NHI.
On April 20, 2008, Tainan Anping Clinic was also found to have fraudulently swiped patients' NHI cards and colluded with contracted care and nursing centers to swipe NHI cards of non-hospitalized citizens, fraudulently claiming NHI funds. Prosecutors estimated that the clinic had illegally profited over NT$13.75 million in more than three years. Prosecutors strongly suspect that other care, nursing, rehabilitation, and dialysis centers may have similar fraudulent practices and will conduct a comprehensive investigation.
Source: http://tw. news. yahoo. com/ article/ url/ d/ a/ 080728/ 78/ 11m. html