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on september 21, cctv reported that private medical institutions in wuxiwuxi hongqiao hospital suspected of insurance fraud。

wuxi municipal medical insurance bureau issued a statement in the early morning of september 22, responding that it had accepted the investigation and preliminarily verified the clues of the report.administrative case filing on august 30; we are currently conducting a comprehensive investigation in conjunction with the public security, health and other departments.will be severely investigated and dealt with in accordance with the law。

previous report: one ct scan contains multiple medical records, and a doctor reported the hospital for suspected insurance fraud

source: cnr

according to china national radio, wuxi hongqiao hospital in jiangsu province is a grade-a class-ii general hospital and a designated medical insurance institution. doctors of the hospital's radiology department reported to the china national radio news hotline 400-800-0088 that since last year, some medical records of patients who had never undergone imaging examinations in their department have appeared in the hospital system. they did not have films taken here, nor did they have imaging numbers filed by the radiology department, but the medical records had "diagnosis based on imaging".

all these medical records were completed by a doctor in the hospital's physical examination center, who did not have the authority to operate the ct and mri machines in the radiology department. depending on the body part, the price of taking a film ranges from 300 to 600 yuan, plus other treatment costs for these "patients" during their stay in the hospital. the doctor in the radiology department suspected that the hospital was suspected of falsifying medical records to defraud medical insurance.

dr. zhu chenggang from the radiology department of wuxi hongqiao hospital reported that since july 2023, he has found that some patients' medical records do not have "imaging numbers" or computed tomography (ct) or magnetic resonance imaging images, but the medical records have "diagnosis based on imaging". these medical records were written by dr. chen from the hospital's physical examination center.

zhu chenggang told reporters: "this person is not usually involved in the work of the radiology department. the hospital specifically asked him to produce reports and fabricate false medical records to defraud insurance. the imaging reports he produced all had no imaging numbers and no images. for various reasons, we reported him."

these medical records not only lacked films and image numbers, but some even did not mark the examination site. zhu chenggang compared it to a newborn baby being registered without a name or birth certificate. from the perspective of the radiology department, such results are simply unworkable, because the ct machine cannot start scanning without entering the image number.

in the ct machine operating room, zhu chenggang demonstrated that in the operating interface, the patient image number is a required field. if it is blank, the scan button will be gray and cannot be clicked. only after the number is entered and the button turns green can the operation continue.

so the radiology department suspected that someone had bypassed them and directly modified the medical records from the hospital backend. dr. li (pseudonym), an insider in the radiology department, told reporters: "if you don't enter the image number during the examination, the machine won't run the next step. he can't even do the examination. there are only false reports without image numbers."

zhu chenggang showed reporters photos of the medical records of 99 "patients". the diagnosis time was concentrated from july to december 2022 and april 2023, and the age range was between 60 and 80 years old. these were some of the problematic medical records he took at work. in march of this year, zhu chenggang took photos of the medical records without image numbers as evidence and reported them to the hospital's superior management department under his real name. later, while waiting for the results of the investigation, zhu chenggang discovered that the medical records he reported had image numbers and films again. in june, he took photos of these medical records one by one. zhu chenggang told reporters that he carefully compared these image numbers. the numbers only existed in the computer system, and these patients were not found in the handwritten notebooks of the radiology department. the encoding method of the image number in the computer system is also different from the daily encoding method of the radiology department. in addition, he found other problems.

for example, among the patients reported, the medical records of 72-year-old "yang xx" and 62-year-old "qiu xx" had diagnoses based on the film taken, but no corresponding images could be found. in june, their ct images were found again. according to the system records, they both had chest ct scans in april 2023. it can be clearly seen on the film that the shape, size and position of the pendants of the two patients are basically the same. not only do these two elderly patients have similar ct images, zhu chenggang also found that the film of ye, a 25-year-old woman who had a ct scan in their department in 2021, also had a pendant that looked very similar. to the naked eye, the films of the three of them are almost identical.

dr. li, an insider of the radiology department, told the reporter: "this person, qiu, is a fake (medical record). he is 62 years old. this is a fake image. how can he look like a 62-year-old woman? we have seen the pendant of the necklace and its characteristics. yang is 72 years old, female. looking at the image, is it one person?"

there are many similar films. for example, the system shows that patient li had a chest ct scan on april 28, 2023, and her image is highly similar to the image of the actual patient liu in february 2024. 74-year-old patient mo had a chest and cervical spine ct scan on april 27, 2023. her film looks highly similar to the film of the actual patient ma, 37, taken in november 2023. you can see in the film that the necklaces are exactly the same.

in addition, through the hospital system query, it can be seen that one patient had another mri within 1 minute of the normal mri examination. dr. li said that their machine takes at least 10 to 15 minutes to do a lumbar mri, and it is impossible to do an mri in 1 minute: "it started at 11:40, and the lumbar spine took 15 minutes, but at 11:41, he cheated the insurance again. how could you do an mri in 1 minute?"

dr. li told reporters that some films have such errors: when taking the film, the patient is facing the doctor, and the left side on the film is actually the patient's right side. however, the diagnosis of a patient's medical record says "left cerebral infarction", but her film shows the right side: "(the patient) is 73 years old, and the report says there is infarction in the left basal ganglia. where is it actually? this is called the right side, which is the image of a person standing opposite you. this is a false image filled in later."

just after zhu chenggang reported these new developments to the higher authorities, he and his colleagues discovered that the radiology department no longer had the authority to view images before august 2023. the hospital gave the reason that the error was caused by a system upgrade. "we locked the permissions, and he said it was a system upgrade. it's possible that the system was messed up during the upgrade. isn't that ridiculous?"

zhu chenggang then took the reporter to the radiology department office, where the reporter saw that the medical records that had been reported in the system could no longer be opened.

from "diagnosis but no images and image numbers", to images appearing after the report, but with images of multiple patients highly similar to those of others, to the inability to view images and medical records, zhu chenggang suspected that the medical records of the patients involved had been modified many times, which was a forgery of medical records to defraud medical insurance.

zhu chenggang said: "here is the list of people who committed insurance fraud, and here is the source of the image. before the image was locked, (i) took a picture and recorded the source of the fake image of the person. after reporting the insurance fraud without an image number and a picture, i added the fake image number and reported the source of the fake image to them. now the image cannot be opened."

on july 12, the wuxi municipal medical insurance bureau told zhu chenggang that it attached great importance to his report and went to wuxi hongqiao hospital for on-site verification twice. it checked the clues through the medical insurance information system, extracted medical records and contacted the hospitalized people at the time to verify the situation, and questioned the doctors involved on the spot. however, because the clues provided involved many people and the problems reflected were a long time ago, the clues provided could not be confirmed and verified in the early verification. for this reason, we specially coordinated and communicated with the wuxi public security department and submitted the relevant clues to the public security department for assistance in the investigation. the public security department will inform you in time if there is clear feedback after verification. if relevant medical insurance regulations and agreements are violated, they will be dealt with seriously. if it involves violations of the law, it will be handed over to the public security department for handling.

dr. li from the radiology department said that they are looking forward to the follow-up investigation. the hospital's underlying imaging archiving and communication system should record every modification of the medical record. he told reporters: "this report was modified 100 times in our pcas (imaging archiving and communication) system, and it was written 100 times in the modification system. but the hospital locked us out, and we can't retrieve it once it is locked."

the reporter randomly called the phone numbers of 20 patients left in medical records. three-quarters of the numbers were invalid or could not be reached, and most of the people who answered said it was not the real person.

reporter: is this mr. qiu’s phone number?

respondent: no, it isn’t.

reporter: is this...'s call?

answerer: you have dialed the wrong number. you have dialed the wrong number.

some patients who answered the phone also said that they were hospitalized for a physical examination. for example, ms. xu said that she went to wuxi hongqiao hospital for a physical examination because of back pain, but as to why she only had a chest ct scan, ms. xu said that it had been a long time and her memory was not very clear.

ms. xu: i think my waist hurts.

reporter: why do we need a chest ct scan?

ms. xu: i forgot. how could i remember it after such a long time? anyway, when i got to the hospital, i did whatever they said.

the fund supervision department of the wuxi medical insurance bureau stated that the matter is still under investigation and it is not convenient to disclose the specific details.

fund supervision department: we have relevant regulations, and we are in the process of investigating and handling. i am not in a position to tell you the specific progress.

reporter: every time a doctor reports a situation, relevant evidence will be provided.

fund supervision department: this is only the doctor’s one-sided statement. the specific situation will depend on the final investigation results.

the reporter contacted wuxi hongqiao hospital, and the hospital said that relevant personnel would respond, but as of press time, no response was received. why are so many films so similar? have the medical records been altered? it has been about half a year since the doctor reported the case in his real name. when will there be a definite investigation result? china voice will continue to pay attention.