Nghe An: Numerous suspicions of health insurance fraud.

(Baonghean.vn) – On the afternoon of July 6th, the Nghe An Department of Health held an online conference to summarize the health work in the first six months of the year and to implement key tasks for the last six months of 2017. At the meeting, leaders of the Nghe An Social Insurance and the Department of Health raised several "unusual" signs indicating potential health insurance fraud.

Mr. Le Truong Giang, Director of the Social Insurance Department of Nghe An province, said: Many cases of health insurance fraud are still being detected. Photo: Thanh Son

At the meeting, Mr. Le Truong Giang, Director of the Provincial Social Insurance Department, reported that in the first six months of the year, an additional 90,000 people joined health insurance, raising the health insurance coverage rate to 82.4%. While the fund has increased, the risk of health insurance deficit in 2017 remains high.

To minimize health insurance fraud, it is recommended that medical facilities effectively implement the health insurance claims information system, especially the retrieval of patients' medical history. Thanks to a search at Cua Dong General Hospital, the Social Insurance agency discovered two typical cases of abuse: one at Nghi Phu Commune Health Station, Vinh City; and the other at Tuong Son Commune Health Station, Anh Son District.

When questioned, the patient insisted they had not visited the commune health station, while data on the portal showed they had. The provincial Social Insurance agency verified that out of 1,268 payment declarations at the Tuong Son commune health station, 168 were either unsigned by the patient, signed by one person for multiple declarations, or where medical staff used family members' health insurance cards to obtain medication.

Biochemistry laboratory technicians at the Provincial General Hospital. Photo: Duc Anh

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

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

Prenatal care for 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 (rupture of pus into the abdominal cavity due to acute appendicitis), with pseudomembranes, digestive fluids, bile, and urine. It is a serious complication of acute appendicitis, with a high risk of death. These statistics lead to two conclusions: firstly, overuse of certain medications, and secondly, extremely poor healthcare capacity at the grassroots level in Nghe An province.

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

Thanh Son