Nghe An: Health station head falsifies records to defraud health insurance fund.

Accordingly, at the Dien Quang Commune Health Station, the verification team of the Provincial Social Insurance checked, verified, and compared the health insurance payment request forms from January 1, 2018, to February 28, 2018, and selected 20 forms for further verification.

Of the 20 patients on the list of those covered by health insurance at the Health Station, 12 could not be verified because the individuals were absent or could not be contacted; the verification team directly worked with the remaining 8 patients.

Conclusion of the Nghe An Provincial Social Insurance Agency regarding the verification of health insurance medical examinations and treatments at Dien Quang Commune Health Station, Dien Chau District. Photo: Phuoc Anh.

As a result, in addition to the 5 patients who used their health insurance cards to receive medical treatment at the Dien Quang Commune Health Station in accordance with regulations, there were 3 patients who did not seek medical treatment but still had health insurance records at the station. Of these 3 patients, 1 has passed away, 1 is currently residing in Hanoi, and 1 did not seek medical treatment at all!

In addition, the verification team also worked directly with a local resident, Mr. Le Van T., residing in Hamlet 3. He affirmed that on February 6, 2018, he did not go to the Dien Quang Commune Health Station for health insurance-covered medical examination and treatment, and the signature on the medical expense payment slip and prescription issued by the Station Chief was not his.

During questioning, the head of the Dien Quang commune health station admitted that from January to February 2018, he fabricated five health insurance medical examination and treatment records to claim reimbursement for health insurance expenses without the patients being present. The amount requested for reimbursement from these fabricated records was 432,040 VND.

Thanks to timely detection, although the amount of money defrauded from the health insurance fund was not large, the actions of the Head of the Dien Quang Commune Health Station violated regulations on creating medical records and prescribing medication for patients who did not actually exist, as stipulated in Article 66 of Government Decree No. 176/2013/ND-CP dated November 14, 2013, on administrative penalties in the field of health.

Illustrative image.

The Social Insurance Department of Nghe An province refused to pay the amount resulting from the fraudulent documentation created by the Dien Quang Commune Health Station. Simultaneously, it requested relevant agencies, based on their functions, to impose administrative penalties on the head of the commune health station; rectify the consequences caused by the administrative violation; immediately address shortcomings in health insurance medical examination and treatment; ensure that examinations, medical records, prescriptions, and medication are administered correctly to patients; and strictly check health insurance medical examination and treatment procedures for those with health insurance cards when seeking medical care…

In addition, an inter-agency inspection team, established by the Dien Chau District People's Committee, was set up at the Dien Quang Commune Health Station to investigate the falsification of health insurance medical examination and treatment records…