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Hospital probed for insurance fund fraud

By An Baijie and Xiang Mingchao (China Daily)

09:11, February 20, 2012

ZHENGZHOU - The local government is investigating allegations of insurance fraud against a private hospital in Zhengzhou, capital of Central China's Henan province.

The Zhengzhou Harmony Hospital is believed to have illegally acquired more than 628,000 yuan ($99,700) from 2008 to 2010 by making fraudulent clinical reports, said Shi Liang, deputy director of the Zhengzhou Medical Insurance Center.

The manager of the hospital, who has already fled to the United States, borrowed medical cards from acquaintances who were not actually patients. The manager counterfeited clinical reports, prescribed medicine for the non-existent patients and billed the city's medical insurance fund for the costs.

Shi said regulations allow a hospital to recover 80 percent of the medical fees charged from the city insurance fund.

The hospital was also found to have contracted one of its departments to individuals, which made the fraud difficult to trace, according to a report released by the medical insurance center last Tuesday.

Receiving whistleblowing from local residents, the medical insurance center canceled the hospital's eligibility for medical insurance reimbursement in January 2010, Shi said. But the center did not make public the case at that time.

The local government started a two-month inspection of all of the city's hospitals after the case was found out and reported by the Xinhua News Agency in early February. It vowed to crack down on hospital managers who attempt to defraud the insurance fund.

Li Xiang, who reported the case to the center and local police, said his mother's medical card was used five times from 2007 to 2009, during which time his mother had not been to the hospital.

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