Nghe An: Forging insurance books to receive pension benefits

(Baonghean) -In recent years, violations of the law on social insurance (SI) and health insurance (HI) have become increasingly common, not only causing damage to the SI and HI funds but also directly affecting the rights of workers and social security policies. Recently, the provincial Social Insurance has discovered cases of falsifying social insurance books to receive pensions and medical stations forging signatures to profit from the fund.

Forging insurance books to receive pension

In July 2016, Ms. Nguyen Thi Nga, a specialist of the Provincial Social Insurance Regime Department (BHXH), reviewed the application to resolve the pension regime for employees. At this time, Ms. Nga discovered some suspicious information such as the handwriting in the insurance book, working time... of Mr. Nguyen Quang Thanh (residing in Quynh Doi commune, Quynh Luu district) matched the book of Mr. Nguyen The Phuong (57 years old, Quynh Van commune, Quynh Luu district) which had been paid before.

Information in the insurance book shows that Mr. Phuong works at Dong Nai Traffic Construction Joint Stock Company. Meanwhile, information in Mr. Thanh's insurance book shows that he worked at the General Department of Logistics (Ministry of National Defense).

Suspecting that the insurance book was forged, Ms. Nga immediately reported to the agency's leaders and contacted the Dong Nai Provincial Social Insurance and the National Defense Social Insurance for verification. Thereby, it was determined that the list of participants and social insurance collection data of Dong Nai Traffic Construction Joint Stock Company managed by Dong Nai Provincial Social Insurance, from October 1983 to February 2006, did not include Mr. Nguyen The Phuong's name. Mr. Phuong's social insurance book was issued on October 30, 2003 and was signed by Ms. Huynh Lang Anh - Director of Dong Nai Provincial Social Insurance. However, Ms. Anh had retired at this time.

Tuong Son Commune Health Station (Anh Son). Photo: Huyen Trang

At the time of closing the social insurance book in February 2006, the signature was not that of Mr. Pham Minh Thanh - Deputy Director of Dong Nai Province Social Insurance, the seals of Dong Nai Province Social Insurance and Trang Bom District Social Insurance were also fake. Similar to Mr. Phuong's social insurance book, the information on Mr. Thanh's book was determined to match that of an officer currently working at the General Department of Logistics. The seals and signatures were all fake...

Nghe An Provincial Social Insurance then stopped paying pension to Mr. Nguyen The Phuong from September 2016, and transferred the above two files to PC46 Department of Nghe An Provincial Police for further investigation and clarification. In April 2017, the Provincial Police recovered more than 42 million VND and returned it to the Social Insurance Fund. This is the amount of money that was paid for Mr. Phuong's pension from October 2015 to August 2016.

Medical station forged signature

In June 2017, Social Insurance officers suspected fraud after looking up the medical examination and treatment history of some patients through the health insurance assessment information system. Data on the assessment portal showed that some patients repeatedly came for medical examination and treatment, but these people affirmed that they had never been to the health station. Immediately, the Director of Nghe An Province Social Insurance established a working group to directly investigate the case.

The team then verified at a number of health stations, including the Tuong Son Commune Health Station, Anh Son District. Checking and comparing nearly 1,300 health insurance payment request forms of this station in less than 3 months (from the beginning of April to June 21, 2017), the working group determined that the Tuong Son Commune Health Station had created 153 lists of medical examination and treatment costs and prescriptions without any patients. Of these, 55 lists were forged by staff of the Tuong Son Commune Health Station with the signatures of health insurance cardholders, and 98 cases did not directly go to the clinic but asked cardholders to come to the station to request medicine. This behavior violated the provisions of Article 66 of Decree 176/2013/ND-CP dated November 14, 2013 on administrative sanctions for violations in the health sector.

The Social Insurance Working Group also concluded that Tuong Son Commune Health Station did not follow the instructions on using the list of medical examination and treatment costs issued by the Ministry of Health. Specifically, 15 lists did not have the patient's signature, 169 lists had one person signing on behalf of many people but did not clearly state the relationship, and patients were not confirmed about the content and quantity of services used during the examination and treatment process at the health station...

Explaining these violations, Mr. Le Trung Tien - Head of Tuong Son Commune Health Station said that in the case of patients who had not signed the form, it was because those days coincided with vaccination days in the commune. "The health station is somewhat considerate in examining and treating patients under health insurance, one person holding many health insurance cards comes to the clinic to get medicine for another person. For example, the families of Ms. Nguyen Thi Trung, Ms. Thuan, and Ms. Binh asked Ms. Trung to sign on their behalf. Ms. Trung used to work as a village health worker, so it was difficult for the health station to explain" - Mr. Tien explained.

Ms. Nguyen Thi Huong - Director of Anh Son District Health Center said that the problems that Tuong Son Commune Health Station encountered were reminded by the health center many times in meetings. After this incident, the health center will force Tuong Son Commune Health Station to learn from experience, immediately stop this phenomenon, and at the same time not let it happen again. "The district health center will send a document to local authorities at all levels in the area to correct the violations that the working group pointed out" - Ms. Huong said.

In response to these violations, Nghe An Provincial Social Insurance decided not to accept the settlement of all health insurance examination and treatment costs on 70 statements of Tuong Son Commune Health Station with a total amount of more than 5 million VND. Of these, 15 statements did not have the patient's signature, and 55 statements had their signatures forged by station staff. At the same time, the Provincial Social Insurance also requested Anh Son District Health Center to take appropriate legal action against the violations of Tuong Son Commune Health Station; issue documents to rectify health insurance examination and treatment at affiliated health stations as well as regularly inspect and guide the stations in health insurance examination and treatment.

After this scandal, the provincial Social Insurance is also requesting the Anh Son District Social Insurance to re-evaluate the health insurance examination and treatment work in 2016 and the first quarter of 2017 of the Tuong Son Commune Health Station; to check and clarify 169 lists with one person signing on behalf of many people; to verify how many people actually brought their health insurance cards to see a doctor or get treatment, and how many people did not go directly to the clinic but asked someone else to bring their health insurance cards to the station to request medicine.

Tien Hung