Seven hospitals in Huainan city in East China”s Anhui province are suspected of misusing medical insurance funds by fabricating hospitalization and examination records, according to the National Healthcare Security Administration.
The administration released information about the case to the public in a circular on Wednesday as efforts aimed at cracking down on insurance scams have intensified in recent months.
According to the circular, a rural private hospital in Shouxian county in Huainan had colluded with two elderly care centers to coax patients into the hospital.
For each patient who checked in, the hospital paid 200 yuan ($28.10) to the center that facilitated the visit.
It was also found that the hospital had forged imaging test results ordered by doctors who had either never worked there or who were out of office.
Some CT imaging reports were inconsistent with the actual services rendered or were completely fake.
Local authorities have so far retrieved defrauded funds, handed penalties to two medical workers involved and revoked their medical licenses.
An investigation group comprising public security, health and medical insurance officials has been dispatched to the hospital to further probe the problem.
In another case, a rural hospital in the city’s Liuwei village is suspected of issuing counterfeit diagnosis reports for 2,700 medical consultations.
Two medical workers were found to have provided spinal anesthesia or traditional Chinese medicine services that they were not certified to perform. More than 1,000 illegitimate reports were generated by them, according to the circular.
Another TCM hospital in Shouxian faked the use of injections and artificial lenses and provided false diagnoses of lumbar disc herniations to defraud public insurance funds.
Other cases also involve community health centers and elderly rehabilitation hospitals.
The administration said that further investigation is underway, and local healthcare security authorities have launched an inspection campaign to strengthen supervision of medical institutions’ use of insurance funds.
The National Healthcare Security Administration has ramped up oversight of insurance funds to curb misuse.
Earlier this month, it announced the establishment of a points-based credit system for healthcare professionals certified to process medical insurance funds.
Last week, the administration said that it will strengthen the management of the social supervisors comprising legislators, political advisers, media professionals, representatives from insurance-designated medical institutions, experts and insured residents.
They will be tasked with supervising the use of healthcare insurance, reporting irregularities and putting forward suggestions to improve medical insurance policies.
