news

한어Русский языкEnglishFrançaisIndonesianSanskrit日本語DeutschPortuguêsΕλληνικάespañolItalianoSuomalainenLatina

the wuxi medical insurance bureau issued a notice in the early morning regarding a doctor's real-name report of a hospital suspected of insurance fraud.

in the early hours of this morning, the wuxi municipal medical insurance bureau issued a report stating that on september 21, the media reported that the private medical institution wuxi hongqiao hospital was suspected of insurance fraud. in the early stage, the wuxi municipal medical insurance bureau had accepted the investigation and preliminary verification based on the clues of the report, and filed an administrative case on august 30. at present, the bureau is conducting a comprehensive and thorough investigation with the public security, health and other departments, and will severely investigate and deal with it in accordance with the law.

one ct scan contains multiple medical records? doctor reports hospital for suspected insurance fraud

according to a previous report by cctv news client, recently, dr. zhu from the radiology department of wuxi hongqiao hospital in jiangsu province reported to the china voice news hotline under his real name that since last year, some medical records of patients who had never undergone imaging examinations in their department have appeared in the hospital system, but the medical records have "diagnoses based on imaging." these medical records were all completed by dr. chen from the hospital's physical examination center, and this doctor did not have the authority to operate the ct and mri machines in the radiology department.

△the problematic medical record taken by dr. zhu in march 2024 contains relevant content based on imaging diagnosis, but there are no images and imaging numbers.

dr. zhu suspected that the hospital was involved in falsifying medical records and defrauding medical insurance. in march this year, he took photos of the medical records without imaging numbers as evidence and reported them to the hospital's higher management department under his real name. while waiting for the results of the investigation, the medical records he reported had imaging numbers and films. subsequently, he discovered more problems, including:

the images of multiple patients are highly similar to those of others

perform 2 mri scans in 1 minute

the left-right correspondence between the image and the diagnosis is incorrect

△after being reported, fake images and fake image numbers were added.

after more problems were discovered, the problematic medical records were restricted and could no longer be viewed.

the national health insurance administration announced 13 cases of falsely hospitalizing insured persons to defraud insurance

on september 19 and 20, the national health insurance administration announced two batches of 13 cases involving suspected violations of laws and regulations behind abnormally high hospitalization rates. the cases announced this time mainly involved hospitals in chongqing and parts of sichuan province that lured insured persons with no hospitalization indications to falsely hospitalize to defraud insurance.

the national health insurance administration said that big data analysis showed that the hospitalization rate of the masses in some areas was significantly higher than that in other areas, and the hospitalization rate of patients in some hospitals was abnormally high and extremely abnormal. according to the clues of the big data model, the national health insurance administration, together with the medical insurance departments of chongqing and sichuan province, carried out special flight inspections on areas with high hospitalization rates. the inspection found that some hospitals lured insured persons with no hospitalization indications to falsely hospitalize and defraud insurance by giving cash, car pick-up and drop-off, free meals, etc. the medical institutions involved conspired with insured persons who did not need hospitalization to fabricate medical services, forge diagnosis reports, and impersonate doctors to defraud medical insurance funds, resulting in an abnormally high regional hospitalization rate.

the cases announced this time involve six hospitals in chongqing, including the kangning hospital in hechuan district, chongqing, which clearly marked prices for hospitalization and paid a referral fee of 300 yuan for each hospitalization. it is suspected of inducing patients to be hospitalized for insurance fraud, false hospitalization for insurance fraud, fictitious medical services for insurance fraud, and forged inspection and test reports for insurance fraud; the kanggu hospital in hechuan district, chongqing, is suspected of privately engraving seals, false propaganda in the name of others, and practicing medicine in a false name for insurance fraud; it is suspected of privately engraving seals and condoning unqualified personnel to forge medical documents for insurance fraud; the huaxin obstetrics and gynecology hospital in kaizhou district, chongqing, is suspected of inducing hospitalization for insurance fraud by providing food and accommodation, and is also suspected of fabricating the costs of moxibustion and chinese herbal medicines for insurance fraud, chinese medicine practitioners' package prescriptions and package medication for insurance fraud, and unqualified personnel are suspected of practicing medicine without a license for insurance fraud.

seven cases involved sichuan province. among them, some inpatients of fushun west district hospital in zigong city, sichuan province were hospitalized frequently in multiple medical institutions including the hospital. one patient was hospitalized 16 times for 187 days in 2023, suspected of inducing insured persons to defraud insurance by hospitalization without indication, defrauding insurance by fictitious medical services, excessive medical treatment and ineffective medical treatment. since 2022, 125 people have been hospitalized more than 10 times in qingkang hospital, qu county, dazhou city, sichuan province. most of them were admitted to the hospital without outpatient treatment. the number of approved beds is only 30, but the highest number of inpatients per day is as high as 108. it is suspected of inducing insured persons to defraud insurance by hospitalization without indication, suspected of forging medical documents, and defrauding insurance by fictitious inspection and testing services, and unqualified personnel are suspected of forging medical documents to defraud insurance. sanban town health center in dazhou city, sichuan province has been hospitalized for insurance fraud with high frequency and low indications. since 2022, 7 people in the hospital have been hospitalized more than 20 times, and 33 people have been hospitalized more than 10 times. most of them do not meet the indications for admission and are over-diagnosed. they are also suspected of forging color ultrasound reports, defrauding insurance by fictitious inspection services, and defrauding insurance by fictitious traditional chinese medicine treatment services.

it is reported that the medical insurance departments of chongqing and sichuan province have taken measures such as suspending or canceling the medical insurance service agreements of relevant hospitals, initiating administrative penalty procedures, and transferring clues of the problems to the public security and other relevant departments for disposal. in addition, the medical insurance departments of the two places have carried out expanded inspections on similar issues and increased the intensity of inspections and crackdowns. the medical insurance department of chongqing has currently preliminarily checked 52 institutions, closed 7 institutions, and transferred 6 institutions to the public security organs or jointly investigated with the public security organs. the medical insurance department of sichuan province further verified that 71 medical institutions had similar problems as mentioned above. at present, the medical insurance service agreements of 24 institutions have been canceled and 30 institutions have been suspended, and the clues of illegal activities of 60 institutions have been transferred to the public security organs.