Medical station forged patient's signature to get insurance payment

(Baonghean.vn) - The provincial Social Insurance has refused to pay the medical examination and treatment costs of 70 cases in Tuong Son commune (Anh Son), after discovering many violations at this medical station.

Nghe An Province Social Insurance has just decided not to accept the settlement of all health insurance examination and treatment costs of 70 cases established by Tuong Son Medical Station (Anh Son District) with a total amount of more than 5 million VND.

Of these, 15 lists did not have the patient's signature, and 55 lists had signatures forged by station staff. The provincial Social Insurance also requested the Anh Son District Medical Center to handle the violations and issue a document to rectify the health insurance examination and treatment work at its affiliated medical stations.

Previously, after looking up the medical examination and treatment history of some patients through the health insurance assessment information system, social insurance officers suspected signs of profiteering, so they set up a verification team. Data on the assessment portal showed that some patients continuously came for medical examination and treatment, but these people affirmed that they had never been to the health station.

Payment request forms without patient signature. Photo: Tien Hung

Checking nearly 1,300 health insurance payment request forms of Tuong Son Medical Station in less than 3 months (from the beginning of April to June 21, 2017), the working group determined that this station had created 153 medical examination and treatment cost and prescription forms without any patients in reality.

Among them, 55 statements were forged by station staff with signatures of health insurance card holders, and 98 cases involved people not going directly to the clinic but asking card holders to come to the station to request medicine.

The Social Insurance Working Group also concluded that Tuong Son Medical Station did not follow the instructions on the use of medical examination and treatment cost lists 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 medical examination and treatment process at the medical station...

Statements of different cardholders but with the same signature. Photo: Tien Hung

Explaining to the working group, Mr. Le Trung Tien - Head of Tuong Son Health Station, said that in the case of patients who have not signed the list, it is because those days coincide with vaccination days in the commune. "Regarding the signing on behalf, the Health Station is somewhat considerate in examining and treating patients under health insurance. A person holding many health insurance cards comes to the clinic to get medicine for others. 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 is difficult for the Health Station to explain," Mr. Tien explained.

Ms. Nguyen Thi Huong, Director of Anh Son District Medical Center, said that the problems that Tuong Son Medical Station encountered were reminded by the medical center many times in meetings. After this incident, the medical center will force this commune medical station to learn from its experience and not let it happen again. "The district medical 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.

After this incident, 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. Check and clarify 169 lists with one person signing on behalf of many people; verify how many people actually brought their health insurance cards to see a doctor, how many people did not go directly to the doctor but asked someone else to bring their health insurance cards to the station to request medicine./.

Tien Hung