Anhui hospitals are involved in $ 9 million insurance fraud

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Dozens of health facilities in eastern Anhui Province have been found to have embezzled nearly 58 million yuan ($ 9 million) from public health insurance, according to the state-run Xinhua News Agency reported Sunday.

Xinhua said provincial authorities revoked the medical licenses of four hospitals and the professional qualifications of 14 employees from the Taihe County Health Security Administration after an investigation into malpractice. A total of 19 officials in the county – as well as in Fuyang, the city that administers Taihe – were held accountable for the fraud, although it is unclear whether they were punished.

Authorities searched hundreds of thousands of patient records from the county’s 50 health facilities for media reports exposed that the health authority entrusted with the operation of the health insurance company embezzled funds from public coffers. All health facilities examined were found to be involved in fraud to varying degrees, although details have not yet been released.

“There are many reasons for such scams,” said a National Healthcare Security Administration official quoted as stated in a separate Xinhua news report. “Subjective factors that require an improved oversight mechanism can lead to this. Another problem could be the lack of understanding of the (GKV) among insurers, hospitals and pharmacies. “

According to Xinhua, nine of the county’s private hospitals have voluntarily applied to suspend or terminate their public health insurance, according to Xinhua.

Of the 1.38 million people in Taihe County, nearly 18% are over 60 years old, with many in frequent need of medical attention. However, locals Sixth Tone spoke to said the scandal had little impact on the community – hospitals in Fuyang are easily accessible – although many are calling for greater accountability.

“Taihe is such a Guanxi-based place,” says a local commented under a news article on the microblogging platform Weibo referring to the Chinese term for personal connections. “I hope the government does a thorough investigation into this scandal.”

When Sixth Tone reached Tuesday, the Tiahe County People’s Hospital, one of the county’s largest facilities, denied their involvement in the scam. A staff member who refused to be identified because of the sensitivity of the issue said it was not immediately clear whether the scandal had any impact on the day-to-day operations of the hospital.

Despite strict government oversight, scams involving public health insurers have made headlines time and again in China. In 2017, two private hospitals opened in the northeastern city of Shenyang exposed for hiring “patients” by third parties, forging their medical records, and prescribing medication that primarily benefited the hospital.

Editor: Bibek Bhandari.

(Header image: People Visual)



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