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Anhui hospital probed for medical insurance fraud

By Zhu Lixin in Hefei | | Updated: 2023-12-05 20:58
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On Sunday, medical insurance authorities in the eastern province of Anhui declared they would reward a whistleblower and punish the liable workers related to a medical insurance fraud case.

According to a statement released by the Wuhu health insurance bureau, the whistleblower, surnamed Yang, reported a suspicion to the central and local medical insurance authorities. The suspicion involved the Wuhu Second People's Hospital allegedly illegally acquiring money from the medical insurance fund during Yang's father's treatment last year.

The father had stayed in the hospital's intensive care unit for 117 days from March 19 to July 12 of last year without the family's company during the treatment. The patient was later transferred to another local hospital and died there in October at the age of 54.

Yang, a doctor of law with some economics training, later analyzed the list of charges by the hospital and suspected it had charged the patient much more than necessary, The Economic Observer reported.

"It was my aunt who found the clues first. A retired accountant, she made an Excel table to record the hospital's charges to calculate the family's daily expenses for fund preparation," said Yang.

Although most of the medical expenses are covered by the government's medical insurance fund, the Yang family should still ensure that the remaining money in the father's hospital account is enough to continue treatment.

However, the hospital repeatedly informed the family of a low balance in their account, which didn't align with the family's calculations.

Yang was sure that some of the charges were fabricated and later reported to the authorities for further investigation.

In August, the provincial authorities started an investigation and informed Yang of the result in September. The investigation shows the hospital overcharged about 218,200 yuan ($30,553).

The authorities recovered 186,914.7 yuan of medical insurance funds, which the hospital illegally acquired. They required the hospital to reimburse the family for 31,287.29 yuan, which the patient's family paid.

The Wuhu city authorities further fined the hospital 56,074.41 yuan and rewarded Yang 5,364.04 yuan for reporting the clues.

The hospital suspended the head nurse. Other related medical workers and officials also received punishment, including warnings and position adjustment, said the statement, adding that further investigation will continue.

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