According to the National Healthcare Security Administration, seven hospitals in Huainan, East China’s Anhui province, are suspected of squandering medical insurance funds by faking hospitalization and examination records.
The government published information about the case to the public in a circular on Wednesday, as efforts to combat insurance fraud have increased in recent months.
According to the circular, a rural private hospital in Huainan’s Shouxian county cooperated with two aged care homes to entice people to visit the hospital.
The hospital paid 200 yuan ($28.10) to the center that facilitated the patient’s visit.
It was also discovered that the hospital falsified imaging test results ordered by doctors who had never worked there or were out of the office.
Some CT scan reports were inconsistent with the actual services provided or were entirely fraudulent.
So far, local authorities have reclaimed looted monies, imposed penalties on two medical workers implicated, and canceled their licenses.
An investigation team consisting of public security, health, and medical insurance officials has been dispatched to the hospital to further investigate the issue.
In another example, a rural hospital in the city’s Liuwei village is accused of submitting fraudulent diagnosis reports for 2,700 medical consultations.
Two medical workers were discovered to have supplied spinal anesthesia or traditional Chinese medicine services for which they were not certified. They generated almost 1,000 bogus reports, according to the circular.
Another TCM hospital in Shouxian used bogus injections and artificial lenses to scam public insurance monies, as well as phony diagnoses of lumbar disc herniation.
Other cases involve community health clinics and geriatric rehabilitation institutions.
The administration stated that additional investigations are continuing, and local healthcare security authorities have initiated an inspection campaign to improve oversight of medical institutions’ use of insurance payments.
To prevent exploitation of insurance funds, the National Healthcare Security Administration has increased oversight.
Earlier this month, it announced the creation of a points-based credit system for healthcare workers who are authorized to process medical insurance monies.
Last week, the administration announced that it will improve the management of the social supervisors, which include legislators, political advisers, media professionals, representatives from insurance-designated medical facilities, experts, and insured citizens.
They will be responsible for supervising the usage of healthcare insurance, reporting abnormalities, and making recommendations to improve medical insurance policies.
