Two people are suspected of taking advantage of health insurance

HCMCSocial Insurance warns two health insurance cases more than 50 times in a short time.

Social insurance recommends that medical facilities when detecting these two patients, with their respective health insurance card numbers, keep the card and photo identification, and notify the examiner. in charge of the unit or head of the insurance agency.

In particular, the 55-year-old man, a resident of Binh Tan district, registered for medical examination and treatment with original health insurance at Trieu An Hospital. From January 1 to March 8, he went to 18 hospitals and examined health insurance 80 times. Specifically, he went 17 times to Go Vap Hospital, 11 times to District 7 Hospital, 10 times to Thu Duc Hospital … The total cost of the health insurance fund to pay for this patient was more than 60 million VND.

The second case is a 66-year-old man, living in District 7, registered for initial medical examination and treatment at Nguyen Tri Phuong Hospital. From January 1 to March 8, he examined more than 50 times at 8 medical facilities in the city.

Mr. Phan Van Men, Director of Ho Chi Minh City Social Insurance, said on March 24, he transferred the 55-year-old’s file to the police agency to investigate to clarify the case. The insurance agency also sent warning information to the Ho Chi Minh City Department of Health about the patient’s “signs of profiting from the health insurance fund”.

Exchange VnExpress, representative of Go Vap District Hospital, where the patient came to the medical examination 17 times, said that this person went to check for diabetes and asthma.

“In the system there are warnings, but maybe due to a large number of patients, the doctor focused on exam not paying attention. The hospital is in a meeting to learn from experience and criticize the related doctors”, the hospital representative said. “How many times the health insurance patients come to see, the doctor will accept the examination and ask if there is any problem with the drug being used. If the prescribed drug is still working well, then no further prescription”.

In 2019, this person used to be examined 149 times at many medical facilities in Ho Chi Minh City. Investigative agencies are verifying two people with this name are one.

For a 66-year-old patient, the insurance agency is reviewing the cost. “If there are signs of self-seeking, they will continue to change the police station,” Mr. Men said, on the evening of March 25.

According to Mr. Men, the insurance agency, since implementing the Health Insurance Assessment Information System, has reviewed and discovered many signs of profiting from the health insurance fund. Thereby, the insurance industry issued a written warning and asked the health sector to direct medical examination and treatment establishments to review and check these cases.

The results showed that in addition to the cases of sudden increase in the number of visits due to medical conditions, prescribed by doctors, there are still many cases of profiting from the fund, which have been handled. “For these cases, it is necessary to warn and strictly deal with the regulations, to ensure the legitimate rights and interests of the insured and the strictness of the law”, Mr. Men shared.

“In the current legal documents on health insurance, there is no regulation to limit the number of medical examination and treatment of participants”, Mr. Men informed. In fact, not all cases of health insurance medical examination and treatment surges are also profitable. For example, the cases of chronic diseases, on the basis of the patient’s medical condition, as directed by the doctor, the patient can increase the number of medical examination and treatment covered by health insurance many times a year.

The Ho Chi Minh City Social Insurance Agency requested the Department of Health of Ho Chi Minh City to direct medical facilities to promptly transfer data to the receiving portal right after the end of the examination, or the end of the outpatient treatment. patient’s inpatient. Facilities that do not incur medical costs of medical insurance during the day must comply with the correct data transfer, by clicking on the “no cost” item.

On March 23, Deputy Director of the Ho Chi Minh City Department of Health, Tang Chi Thuong, also warned that establishments should comply with the medical history of patients on the health insurance assessment information system as soon as possible. get health insurance card. The search helps to detect cases of using the medical card many times, at many different facilities, on the same day to benefit from the health insurance fund.

Le Phuong