Fraud in insurance business, 5 subjects in Nghe An profited more than 1.1 billion VND

Through the work of grasping the situation and managing subjects, Dien Chau District Police discovered a group of subjects with signs of falsifying medical records to profit from insurance with extremely sophisticated methods and tricks, in connection with a number of doctors, nurses, hospital staff, and clinics in the area.

After receiving the information, Dien Chau District Police reported to the Provincial Police leadership, asked for opinions to establish a special working group, conducted verification, collected documents and evidence. Thereby, initially identified 5 subjects in the network, including: NTH (born in 1983) residing in Dien Xuan commune; CTDT (born in 1997) residing in Dien Thinh commune; NTM (born in 1983) residing in Dien Thap commune, Dien Chau district (all 3 subjects work at Dien Xuan Private Internal Medicine Clinic and are insurance agents of Manulife Vietnam Company Limited); LTP (born in 1968, residing in Truong Thi ward, Vinh city; working at the High-quality Medical Examination and Treatment Center, No. 157 Nguyen Phong Sac street, Vinh city) and NVH (born in 1983) residing in Dien Ky commune, Dien Chau district; working at Nam Cau Bung General Clinic.

In which, NTH is the leader of this line.

As an agent of Manulife Vietnam Co., Ltd., NTH realized that the process of paying insurance benefits to customers with broken bones was quite easy, so he came up with the idea of ​​falsifying medical records for profit. Accordingly, H. contacted the customers he managed and offered benefits when falsifying medical records, so many people agreed.

Through acquaintances, H. connected with the remaining 4 subjects to commit the crime. During the working process, when discovering that a patient came to the hospital or clinic for examination and treatment with a broken bone, the subjects proactively approached and proposed to use a different name for the patient for examination and treatment (using the name of the person who purchased health insurance). After that, the subjects kept the medical records to request Manuife Vietnam Company Limited to pay insurance benefits (for each broken bone medical record, the payment will be from 30 million to 150 million VND).

When there were no actual patients, the subjects colluded with some staff working at hospitals and clinics with X-ray functions to edit film images and sign fake documents. These medical examination records were carried out under the form of fee collection, without using health insurance to avoid inspection and supervision by the Social Insurance agency of Nghe An province.

During the investigation, Dien Chau District Police encountered many difficulties in collecting information, documents, and evidence because the subjects were all qualified and knowledgeable people, and at the same time had collusion and shared profits with the beneficiaries. However, with the determination to fight crime to the end, Dien Chau District Police investigated, clarified, and prosecuted the above 5 subjects for the act of "Fraud in insurance business".

Initially, the police determined that the subjects had created 15 sets of fake medical records and made 22 requests for insurance benefit payments to Manulife Vietnam Company Limited, with a total amount paid of more than 1.1 billion VND.

Currently, the Investigation Police Agency of Dien Chau District Police has temporarily detained NTH and applied measures to prohibit the remaining subjects from leaving their place of residence; at the same time, continue to investigate and clarify the case.