Temporarily stop health insurance examination and treatment at a series of hospitals

Vietnam Social Security (VSS) has just disciplined five appraisers in Hai Phong and Ca Mau for violations during the health insurance appraisal process.

On June 28, Vietnam Social Security held a dialogue conference on implementing health insurance policies and laws with private medical facilities.

Accordingly, Vietnam Social Security has temporarily suspended health insurance treatment contracts with a number of private medical facilities due to these facilities' abuse of health insurance funds.

Social insurance answers questions from private hospitals. Photo: NL

Specifically, Thai Thuong Hoang Hospital (Nghe An) has had its health insurance treatment contract suspended because it was billed over 9 billion VND for abusing dental and maxillofacial technical services. Along with that, Viet Nhat Eye Hospital (Hanoi) refused to pay for 184 Phaco surgeries because they were sponsored by a charity, but still requested the Social Insurance to pay the amount of nearly 670 million VND.

In particular, Tam Duc General Clinic (Binh Phuoc) although not qualified in terms of human resources to be granted a License to operate as a General Clinic, not enough specialties to be a facility registered for initial health insurance examination and treatment. In addition, the doctor registered to practice Traditional Medicine as "outside of office hours, on duty days, Saturdays and Sundays" but signed all medical examination and treatment records for patients coming to see Traditional Medicine during office hours, as prescribed and performed by people without a practice certificate...

Mr. Nguyen Van De, Chairman of the Vietnam Private Health Care Association, said that the data published on health insurance abuse should come from a third party, such as the State Audit. The announcement of health insurance abuse must clearly state names and addresses, and cannot be "sweeped" as is currently the case. If any private health facility is at fault, it will not be paid, and if the violation is serious, it will be prosecuted.

"Vietnam Social Security needs to unify the criteria for payment (rejecting payment of incorrect expenses) because each place applies a different method, leading to many payments being suspended for 6-7 months," Mr. De suggested.

Regarding the work of health insurance appraisal, Mr. Nguyen Quang Duy, General Secretary of the Private Hospital Association, said that many private hospitals were suspended and refused to pay hundreds of billions of dong due to re-appraisal. So how to handle the wrong appraisers right from the base when hundreds of billions of dong were refused to be paid, causing many private hospitals to fall into difficulties.

Mr. Nguyen Minh Thao, Deputy General Director of Vietnam Social Security, admitted that there are cases of wrong appraisers. For example, in Hai Phong, 2 appraisers have just been disciplined, in Ca Mau 4 employees, and some other provinces have transferred wrongdoing officials...

According to PLO