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Crackdown aims at medical institutions that defraud national insurance fund

Wang Xiaodong
Updated: Apr 4,2019 8:52 AM     China Daily

Medical institutions will be scrutinized this year for fraudulent practices involving the medical insurance fund, as special campaigns will be launched across China.

Insurance scams will be the focus of a yearlong campaign against illegal medical practices and irregularities that was launched in March by eight central government departments, including the National Health Commission, National Medical Products Administration and State Administration for Market Regulation.

Enforcement officers will look into hospital practices such as deceiving or luring patients to spend money on unnecessary treatments, using social security cards without the knowledge of their holders and charging for nonexistent services to get money from the medical insurance fund, according to a statement from the National Health Commission.

Other illegal practices and irregularities, including medical institutions and physicians trading or renting permits or certificates to practice medicine, practicing medicine without a license, publicizing false medical advertisements on social media and providing unnecessary diagnoses or treatment for profit, will also be punished if discovered, it said.

Following a special campaign launched by the National Healthcare Security Administration last year targeting insurance scams, the administration has ordered its local branches to intensify efforts to fight irregularities this year in medical institutions, including major public hospitals, grassroots clinics, private hospitals and drugstores, the administration said.

The administration will also explore the creation of a blacklist system for medical institutions, doctors and insurance subscribers that have seriously violated insurance regulations, the administration said.

In Shandong province, authorities will also encourage whistle-blowing to fight insurance scams, with rewards offered up to 100,000 yuan ($14,900), it said.

More than 95 percent of the population is covered by basic medical insurance programs, which are heavily subsidized by the government, according to the National Healthcare Security Administration.

Total revenue of the basic medical insurance fund exceeded 2.1 trillion yuan last year, and spending reached nearly 1.8 trillion yuan, it said.

More than 66,300 medical institutions and drugstores across China had been punished as of the end of last year for violating insurance policies during a nationwide campaign targeting insurance scams launched by the administration in September. Of those, more than 1,200 were disqualified from receiving payments from the medical insurance fund, and more than 480 suspects were transferred to judicial organs for criminal investigation. One billion yuan was recovered, the administration said.

Shi Lichen, founder of medical consultancy Beijing Dingchen Consultancy, said insurance scams were not effectively dealt with before the establishment of the National Healthcare Security Administration last year, as supervision was scattered among different departments.

“Inspections are now conducted on institutions that receive payments from the medical insurance fund, including hospitals and drugstores, but punishment should be handed down to the people responsible, rather than just the institutions,” he said. “A blacklist system that punishes violators will be effective in deterring such practices.”