Warning about health insurance card borrowing

(Baonghean) -The situation of patients borrowing health insurance cards to seek treatment only happened sporadically a few years ago, but since the beginning of 2011, the provincial social insurance sector has discovered more than 100 cases.

Commune police... assist in violations

Since the beginning of November, the Health Insurance Assessment Department of Nghe An Social Insurance has received a notification from assessment staff almost every day about cases of health insurance card borrowing that have been discovered. This almost regular occurrence has forced assessment staff to be vigilant with all patients who come to the clinic using health insurance cards, especially those with serious illnesses. From the discovered cases, the insurance industry has also found the "common denominator" of the ways of violation...

"Most cases of people who go to health insurance clinics and declare that they have lost their ID cards mean they are using a borrowed card," affirmed Dr. Nguyen Xuan Loan, Head of the Health Insurance Assessment Department (Provincial Social Insurance). To avoid the authorities, patients without health insurance cards ask people with health insurance cards to go to the police station of the commune (ward) where they live to verify the loss of their ID cards. It is worth mentioning that although they know clearly that the names and photos of the declarants are completely different, in many places the commune police still turn a blind eye, signing and stamping the photos as well as the confirmation paper. Such is the case of patient Phung Thi Duyen (residing in Dong Hung hamlet, Phu Thanh commune, Yen Thanh district) who is being treated at the General Clinic of Nghe An General Hospital. Before coming for a check-up, because she did not have a health insurance card, Duyen borrowed the card of Phan Thi Loan (residing in Phu Thanh - Yen Thanh). To be sure, Loan went to the Phu Thanh Commune Police Station to declare that her ID card was lost, then pasted Duyen's photo on it and asked the authorities to stamp it. This confirmation paper was signed by the Commune Police Chief Luu Xuan Hoang himself. The incident was only discovered when the patient went to the Provincial General Hospital for treatment. Previously, because they did not check carefully, Yen Thanh Hospital had ignored this case. Similarly, patient Le Thi Thuy in Quynh Luong Commune, Quynh Luu District borrowed the health insurance card of Ms. Pham Thi Tuyet to go to the Obstetrics Department of the Provincial General Hospital for treatment; patient Duong Thi Phu borrowed the card of Ms. Duong Thi Lan (Phuc Thanh Commune - Yen Thanh)...

The borrowed health insurance cards were discovered and confiscated.

Students also often use borrowed health insurance cards to go to medical facilities. However, for this group, because it is quite difficult to declare the loss of a student card or identity card, most of them rely on luck. Student Tran Thi Thanh - Vinh University accepted the loss of her card because someone else borrowed it to go to Cua Dong General Hospital. After being discovered, Thanh "ran away", did not declare her full name and did not wait for the test results.

Inadequacies in appraisal and punishment

Although in 2011, Nghe An Social Insurance discovered more than 100 cases of using borrowed health insurance cards for medical examination and treatment, according to Dr. Nguyen Xuan Loan, this number does not fully reflect the complexity of current health insurance card management and if not strictly controlled, the insurance industry could lose billions of dong each year. Health insurance assessors themselves can only detect obvious cases, while many other cases with many sophisticated tricks are difficult to detect. For example, when doing procedures, the person who comes to register and the person on the insurance card are the same, but when entering the hospital room, they are replaced by another person.

One of the reasons why the management of patients using health insurance cards is still facing many difficulties is because the number of insurance appraisal staff is too small. Right in Vinh City, currently each doctor in the social insurance appraisal department is in charge of 3 to 4 hospitals. As for appraisal staff, because the number is only 6 people, they have to move from one hospital to another every day. The provincial social insurance also only has enough people to prioritize hospitals with a large number of patients coming for examination at the provincial level such as the Provincial Endocrinology Center, Nghe An General Hospital, Cua Dong General Hospital, Children's Hospital... Also because of the limited number of people, many cases of Nghe An insurance have "missed people", only to be discovered when transferred to the central level. As in 2011, Central Hospital 108 was forced to revoke the card of Ms. Nguyen Thi Thanh (Linh Son Commune - Anh Son District) when she lent the card to patient Nguyen Thi Minh for treatment and requested Nghe An Social Insurance to re-evaluate this subject. Previously, when examining at Anh Son Hospital, the hospital staff and insurance did not detect this case of borrowing the health insurance card. If this case of borrowing the card had not been detected, Nghe An Social Insurance would have had to pay nearly 24 million VND for examination and treatment for patient Nguyen Thi Minh.

The act of lending a card to a person with a health insurance card violates point 2, article 37 of the Law on Health Insurance No. 25/2008/QH12 dated November 14, 2008. However, up to this point, there has not been specific guidance on sanctions for those who lend cards. Therefore, when a patient is discovered using a borrowed card, in addition to confiscating the card and requiring the patient to pay for medical treatment, there is no stronger sanction to deter the above behavior. In the current situation, to rectify this situation, Nghe An Social Insurance has sent a document to the social insurance of urban districts, hospitals and localities requesting that the units strengthen the inspection of health insurance medical examination and treatment procedures, and certify cases of health insurance medical examination. In addition, the industry also calls on people, especially those with health insurance cards, to be aware of their rights and responsibilities when using their health insurance cards, and not to lend their cards to others because if the card is confiscated, the cardholder will be the first to lose their rights.

My Ha