By love-89.com On October 16, the National Healthcare Security Administration of China released information regarding allegations of misuse of health insurance funds at seven hospitals in Huainan, Anhui Province.
According to big data analysis from the National Healthcare Security Administration, certain regions exhibit significantly higher hospitalization rates compared to others, with some hospitals showing abnormally high patient admission rates. In response to these alarming trends, the administration collaborated with local health authorities in Anhui to conduct a special investigation into designated healthcare institutions in Huainan.
During the investigation, it was discovered that some hospitals were luring financially struggling individuals with the promise of “free hospitalization.” In a concerning twist, some nursing homes were found to be sending patients to these hospitals for profit, indicating a conspiracy to commit insurance fraud. Furthermore, some hospitals were found to lack ophthalmologists and appropriate equipment yet were providing ophthalmic services to defraud the system.
For example, Nantan Huimin Hospital in Shou County, Huainan, allegedly induced hospitalizations to commit insurance fraud by partnering with two nursing homes under a medical-nursing cooperation agreement. The nursing homes referred patients, and the hospital compensated them per patient, manipulating the system for profit. Reports also emerged of fabricated medical services, including the unauthorized use of a physician’s name which resulted in 3,433 imaging reports being issued, despite the physician having never worked at the hospital.
Additionally, Kangde Hospital in Huainan was accused of conducting unlicensed diagnostic procedures. Non-qualified personnel operated CT and DR scans in the imaging department, while falsifying reports with the signatures of qualified doctors. The hospital further faced allegations of performing anesthesia and traditional Chinese medicine services without proper credentials.
Authorities stated that follow-up actions related to these cases are progressing, with police, healthcare, and market regulation departments initiating formal investigations. The healthcare department in Huainan is also expanding its inspections across all designated medical institutions to promote compliance with health insurance fund usage.
The National Healthcare Security Administration emphasized that in the era of big data, any trace of illegal or irregular activity will be permanently recorded. They maintain a strict “zero tolerance” policy towards such conduct and are continuously leveraging data analytics to broaden their oversight and enforcement efforts.