Seven hospitals in China are suspected of insurance fraud, overcharging the medical insurance fund by nearly 90 million Chinese yuan each. The methods of insurance fraud are diverse and deceitful. For example, when examining patients’ eyes, some hospitals charge fees separately for the left and right eyes, with some even charging fees three or four times. In abdominal CT scans, they divide the scan into upper abdomen, middle abdomen, and lower abdomen, charging fees three times for one scan, and so on.
The National Health Care Security Administration of the People’s Republic of China announced on November 23 that the People’s Hospital of Inner Mongolia Autonomous Region, the First People’s Hospital of Jiujiang City in Jiangxi Province, Changchun Traditional Chinese Medicine Hospital in Jilin Province, People’s Hospital of Shijiazhuang City in Hebei Province, Gansu Medical College Affiliated Hospital (Pingliang People’s Hospital), Jinan Kidney Disease Hospital in Shandong Province, and Heilongjiang Five Confluences Fung Kang Hospital in Heihe City are among the seven hospitals involved in excessive diagnosis, duplicate charges, over-standard charges, and fragmented charges, all of which are illegal behaviors. The first five hospitals are well-known local tertiary grade A hospitals.
The seven hospitals involved have misused and violated the medical insurance fund by nearly 90 million yuan. The top three offenders are as follows: People’s Hospital of Inner Mongolia Autonomous Region with 82 issues amounting to 34.67 million yuan of violations, People’s Hospital of Shijiazhuang City in Hebei Province with 86 issues amounting to 20.09 million yuan of violations, and Changchun Traditional Chinese Medicine Hospital in Jilin Province with 38 issues amounting to 16.387 million yuan of violations.
These hospitals’ fraudulent methods are diverse. For instance, at the People’s Hospital of Inner Mongolia, when conducting a full abdominal CT scan for a patient, they charge three times for upper abdomen, middle abdomen, and lower abdomen scans, with the total cost exceeding that of a single “full abdominal CT scan.” The First People’s Hospital of Jiujiang charges for eye examinations separately for the left and right eyes, sometimes charging fees three to four times. Changchun Traditional Chinese Medicine Hospital charges multiple times based on the actual testing locations for bone density examinations instead of the number of measurements as required. People’s Hospital of Shijiazhuang City charges based on wound size for changing medication, but they overcharge for minor wounds as if they were major wounds, in addition to standard fees and duplicate charges.
The National Health Care Security Administration has requested the hospitals involved to conduct self-checks and self-corrections, and to refund the overcharged amounts to the medical insurance fund. However, some hospitals have not refunded anything, and some have only refunded less than one percent.
The People’s Hospital of Inner Mongolia Autonomous Region violated by 34.67 million yuan and has not refunded any money within the stipulated time period. The First People’s Hospital of Jiujiang City violated by 5.928 million yuan and only refunded 196,000 yuan. Changchun Traditional Chinese Medicine Hospital violated by 16.387 million yuan and refunded 1.201 million yuan. People’s Hospital of Shijiazhuang City violated by 20.09 million yuan and refunded 1.082 million yuan.