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【2010/04/13 United Evening News Reporter Huang Yufang/Taipei Report】
If Kaohsiung Medical University Hospital’s Appeal is Rejected Again, Penalty Will Be Imposed Immediately
Kaohsiung Medical University Hospital has been heavily penalized by the Department of Health for a case involving a doctor colluding with a fraud ring to scam the National Health Insurance (NHI). The hospital’s obstetrics and gynecology department will face a one-year contract suspension, equivalent to a fine of NT$150 million, marking the harshest penalty ever imposed on a contracted medical institution since the NHI’s inception. The hospital has filed administrative appeals twice, both of which were rejected. If its further administrative appeal is also denied, the NHI Bureau will immediately enforce the penalty.
Other hospitals involved in similar "fake patients, real surgeries" schemes include Kaohsiung Municipal Hsiaokang Hospital’s obstetrics and gynecology department and Keelung Hospital’s surgery department, which will face three-month and one-year contract suspensions, respectively.
With the NHI premium rate increase in April and the draft of the second-generation NHI revealing that 40% of the public will face further premium hikes, many are increasingly concerned about how NHI funds are being used. Health Minister Yaung Chih-liang revealed last night that a hospital would be severely penalized for NHI fraud.
This morning, the Department of Health held a press conference to announce the penalties. Shih Chung-liang, director of the Department of Medical Affairs, stated that a doctor surnamed Hsu at Kaohsiung Medical University Hospital had conspired with a fraud ring to swap cancer tissue samples from five patients and issue false diagnostic certificates, fraudulently claiming NT$370,000 from the NHI and over NT$40 million in insurance payouts. The hospital’s obstetrics and gynecology department will face a one-year contract suspension or a retrospective fine equivalent to one year’s outpatient and inpatient fees, amounting to NT$150 million.
NHI Bureau Director Cheng Shou-hsia strongly criticized the case, stating that while the NHI loss of NT$370,000 may seem small, the doctor’s actions severely violated medical ethics. He emphasized that as a medical center and teaching hospital, Kaohsiung Medical University Hospital’s conduct was "utterly unacceptable."
Although the doctor involved is still under investigation, the NHI Bureau announced the one-year suspension for the hospital’s obstetrics and gynecology department last December. The hospital filed two appeals with the Department of Health, both of which were rejected. It can still file an administrative appeal, but if this is also denied, the NHI Bureau will immediately impose the penalty.
Minister Yaung expressed frustration over the prolonged case, stating, "I’ve grown a bit impatient." He had previously urged the hospital’s president to address the issue publicly, but due to their reservations, the Department of Health decided to proceed with administrative penalties.
Yaung, who has taught part-time at Kaohsiung Medical University for over a decade, expressed regret over the incident. Though he had never taught the doctor in question, he lamented, "Could it be that I failed in my teaching?"
Additionally, the same doctor had previously worked at Kaohsiung Municipal Hsiaokang Hospital, where he was involved in defrauding NT$220,000 from the NHI for three patients, leading to a three-month suspension for the hospital’s obstetrics and gynecology department. Another case involves Dr. Yang Chao-jan at Keelung Hospital, who colluded with a fraud ring, resulting in a one-year suspension for the hospital’s surgery department.
Source: http://udn. com/ NEWS/ NATIONAL/ NATS6/ 5534505. shtml
Yang Zhiliang Takes Tough Stance on Health Insurance Fraud
If Kaohsiung Medical University Hospital’s Appeal is Rejected Again, Penalty Will Be Imposed Immediately
Kaohsiung Medical University Hospital has been heavily penalized by the Department of Health for a case involving a doctor colluding with a fraud ring to scam the National Health Insurance (NHI). The hospital’s obstetrics and gynecology department will face a one-year contract suspension, equivalent to a fine of NT$150 million, marking the harshest penalty ever imposed on a contracted medical institution since the NHI’s inception. The hospital has filed administrative appeals twice, both of which were rejected. If its further administrative appeal is also denied, the NHI Bureau will immediately enforce the penalty.
Other hospitals involved in similar "fake patients, real surgeries" schemes include Kaohsiung Municipal Hsiaokang Hospital’s obstetrics and gynecology department and Keelung Hospital’s surgery department, which will face three-month and one-year contract suspensions, respectively.
With the NHI premium rate increase in April and the draft of the second-generation NHI revealing that 40% of the public will face further premium hikes, many are increasingly concerned about how NHI funds are being used. Health Minister Yaung Chih-liang revealed last night that a hospital would be severely penalized for NHI fraud.
This morning, the Department of Health held a press conference to announce the penalties. Shih Chung-liang, director of the Department of Medical Affairs, stated that a doctor surnamed Hsu at Kaohsiung Medical University Hospital had conspired with a fraud ring to swap cancer tissue samples from five patients and issue false diagnostic certificates, fraudulently claiming NT$370,000 from the NHI and over NT$40 million in insurance payouts. The hospital’s obstetrics and gynecology department will face a one-year contract suspension or a retrospective fine equivalent to one year’s outpatient and inpatient fees, amounting to NT$150 million.
NHI Bureau Director Cheng Shou-hsia strongly criticized the case, stating that while the NHI loss of NT$370,000 may seem small, the doctor’s actions severely violated medical ethics. He emphasized that as a medical center and teaching hospital, Kaohsiung Medical University Hospital’s conduct was "utterly unacceptable."
Although the doctor involved is still under investigation, the NHI Bureau announced the one-year suspension for the hospital’s obstetrics and gynecology department last December. The hospital filed two appeals with the Department of Health, both of which were rejected. It can still file an administrative appeal, but if this is also denied, the NHI Bureau will immediately impose the penalty.
Minister Yaung expressed frustration over the prolonged case, stating, "I’ve grown a bit impatient." He had previously urged the hospital’s president to address the issue publicly, but due to their reservations, the Department of Health decided to proceed with administrative penalties.
Yaung, who has taught part-time at Kaohsiung Medical University for over a decade, expressed regret over the incident. Though he had never taught the doctor in question, he lamented, "Could it be that I failed in my teaching?"
Additionally, the same doctor had previously worked at Kaohsiung Municipal Hsiaokang Hospital, where he was involved in defrauding NT$220,000 from the NHI for three patients, leading to a three-month suspension for the hospital’s obstetrics and gynecology department. Another case involves Dr. Yang Chao-jan at Keelung Hospital, who colluded with a fraud ring, resulting in a one-year suspension for the hospital’s surgery department.
Source: http://udn. com/ NEWS/ NATIONAL/ NATS6/ 5534505. shtml