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Health fraud informants to be rewarded

Wang Xiaodong
Updated: Dec 17,2018 9:09 AM     China Daily

Insurance authorities will financially reward whistleblowers who identify healthcare scams as part of the ongoing fight against fraud, according to a circular released by the National Healthcare Security Administration and the Ministry of Finance.

If the activity was unknown to the local healthcare insurance department before the report, informants could receive a percentage of the amount involved in the fraud after it is proved, the circular said.

Rewards should not exceed 100,000 yuan ($14,480), it added.

The circular was made public on Dec 15 after being released earlier to provincial-level healthcare security administrations.

Members of the public can report fraudulent practices by operators of healthcare insurance funds, medical institutions and pharmacies and their employees, as well as by individual insurance subscribers, it said.

Fraudulent practices include fabricating medical services and documents, providing fake invoices to subscribers, faking of medical service invoices by subscribers, lending a healthcare security card to others or receiving medical services with another person’s card to profit from the fund.

Whistleblowers can use their names or make anonymous reports, but they must confirm their identity before they can collect any reward. Healthcare insurance authorities at various levels should protect the privacy of informants, the circular said.

The introduction of the regulation is the latest effort by healthcare authorities in a campaign to fight insurance fraud.

Last month, a China Central Television report accused two hospitals in Shenyang, Liaoning province, of fraudulent practices, including hospitalizing insurance subscribers after faking diagnoses to get insurance funds. Police detained at least 37 suspects after the report.

At a news conference in November, the National Healthcare Insurance Administration vowed to intensify its fight against insurance scams across China, focusing on hospitals, pharmacies and subscribers. It released telephone numbers for making reports in all 31 mainland provinces, municipalities and autonomous regions.

“Healthcare insurance authorities face severe challenges in supervision of the insurance fund, and fraudulent practices of various sorts continue to occur, which seriously affect the security of healthcare insurance funds,” said Huang Huabo, an insurance fund supervisor with the administration.

“We hope intensifying public supervision will help authorities discover problems in a timely manner and prevent insurance scams,” he said.

China’s healthcare authorities have punished a number of violators since September, when a national campaign was launched to fight scams.

In Changchun, Jilin province, 761 medical institutions were given punishments, including being made ineligible to receive payments from the city’s healthcare insurance fund and even suspension of business, according to the administration.

More than 95 percent of people in China are covered by basic healthcare insurance programs, which are heavily subsidized by the government. Reimbursement policies vary with different groups.