Nghe An: Many suspicions of health insurance fraud

(Baonghean.vn) – On the afternoon of July 6, Nghe An Department of Health held an online conference to review the health sector in the first 6 months of the year and deploy key tasks for the last 6 months of 2017. At the meeting, leaders of Nghe An Social Insurance and the Department of Health pointed out many “abnormal” signs of health insurance fraud.

Mr. Le Truong Giang - Director of Social Insurance of Nghe An province said: There are still many cases of health insurance fraud detected. Photo: Thanh Son

At the meeting, Mr. Le Truong Giang - Director of the Provincial Social Insurance informed: In the first 6 months of the year, there were 90 thousand more people participating in health insurance, raising the rate of population participating in health insurance to 82.4%. The fund source increased but the risk of health insurance deficit in 2017 is still high.

To minimize the situation of health insurance fraud, it is recommended that medical examination and treatment facilities effectively deploy the health insurance appraisal information system, especially tracing the medical examination and treatment history of patients. Thanks to the investigation at Cua Dong General Hospital, the Social Insurance discovered two typical cases of abuse: One is the Nghi Phu Commune Health Station, Vinh City; the other is the Tuong Son Commune Health Station, Anh Son District.

When asked, the patient confirmed that he did not go to the commune health station for examination while the data on the portal showed that he did. The provincial Social Insurance has verified that out of 1,268 payment declarations at the Tuong Son commune health station, 168 declarations were not signed by the patient or one person signed for many or the medical staff used the health insurance card of a relative to get medicine.

Biochemical laboratory technician at the Provincial General Hospital. Photo: Duc Anh

In addition, the provincial Social Insurance also found some abnormalities such as Quy Chau Medical Center had a very high number of test orders of 55,848 times; higher than the delta districts such as Nam Dan (43,654 times), Hung Nguyen (24,558 times), Cua Lo (46,668 times).

Also at the meeting, Pharmacist Hoang Van Hao - Acting Director of Nghe An Department of Health also pointed out the abnormalities in treatment: For example, with laparoscopic surgery for appendicitis, Thanh Chuong General Hospital had 90 appendectomy cases, of which 85 were laparoscopic appendectomy cases; In the first quarter, Tay Bac General Hospital performed 175 appendectomy cases, of which 155 were appendicitis peritoneal cases.

Taking care of pregnant women at Chau Thang Commune Health Station, Quy Chau District. Photo: Thanh Son

Appendicitis peritonitis is an inflammation of the peritoneal membranes due to pus in the abdominal cavity (pus ruptures into the abdominal cavity due to acute appendicitis), with pseudomembranes, digestive fluids, bile and urine. The disease is a severe complication of acute appendicitis, with a high risk of death.... These figures lead to two conclusions: One is abuse, the other is that the medical capacity at the grassroots level in Nghe An is too poor.

Pharmacist Hoang Van Hao stated: In the last 6 months of 2017, Nghe An Department of Health will coordinate with the provincial Social Insurance to strengthen inspection and supervision, and limit the abuse of medical examination and treatment services at hospitals.

Thanh Son