Insurance fraud uncovered at Hefei hospital

Senior medics and administrators at a hospital in Hefei, Anhui province, have been punished after an investigation found they had forged records to make fraudulent insurance claims.

The unlawful practices uncovered at No 3 Hospital Affiliated to Anhui University of Chinese Medicine included providing fake hospitalization documents for patients who did not need inpatient care, so that the government would pay more of their treatment costs.

A probe into possible wrongdoing began after a January report by Xinhua News Agency.

The investigation team, comprising officials from provincial authorities responsible for social security, healthcare and traditional Chinese medicine, concluded that the hospital had committed “severe violations” of laws and government regulations, according to a news released on Friday.

The hospital’s Party secretary was given a “grave warning” while its president received a demerit in his personnel file. The vice-president who was directly responsible for overseeing medical insurance affairs and the director of the hospital’s medical insurance office were both removed from their posts.

Another eight medical personnel, including doctors and nurses, have been banned from practicing medicine for seven months, while two have been prohibited indefinitely from entering the hospital.

In one case, a woman surnamed Chen paid less than 1,000 yuan ($160) to the hospital and received drugs worth more than 1,700 yuan plus a 3,000 yuan card for massage services. However, forged records said she spent 6,000 yuan on her treatment, which means more than 5,000 yuan should come from the government.

The doctors also kept individuals’ medical insurance cards and provided treatment to other people using the cardholders’ name.

Some of the cardholders were patients with rare diseases that enabled them to enjoy more health insurance coverage than others, according to the news release.