Sunday, December 8 2019


City cracks down on health insurance fraud

Update: November, 14/2019 - 08:36


Insured patients wait for medicine at a hospital in HCM City. VNS Photo Gia Lộc

HCM CITY — HCM City agencies are increasing inspections of healthcare facilities that abuse the health insurance fund by prescribing needless tests and overcharging.  

The city's Department of Health and the Việt Nam Social Security as well as other agencies are addressing violations and abuse of the fund in the remaining months of the year.

Any facility found violating the country’s criminal code related to health insurance will be investigated and punished.

The Government, for the first time, has allocated a certain level of funds to health facilities under the health insurance fund for coverage of treatment of insured patients.

The Việt Nam Social Security in the city has reported that expenditures from the fund covering treatment of insured patients at health facilities in HCM City totalled VNĐ13 trillion (US$560 million) in the first eight months of the year, accounting for 72 per cent of the estimated funds which the Government had allocated.

Phan Văn Mến, director of Việt Nam Social Security in the city, told Sài Gòn Giải Phóng newspaper that many hospitals had prescribed many high-tech tests and treatments for their patients.

The number of inpatients and outpatients in the city rose by 9.3 per cent and 5 per cent, respectively, in the first eight months compared to the same period last year. This led to increased costs that had to be covered by the fund.

In the first eight months, the city had nearly 7.3 million people with health insurance cards, an increase of 490,000 against the same period last year.

Many insured patients from other provinces also visited city hospitals for treatment. According to the Department of Health, the number of insured patients from other provinces rose by 6 per cent in the first half of the year against the same period last year.

Mến said he was concerned that the city’s fund would lack VNĐ1.8 trillion to cover treatment of insured patients by the end of the year.

Dr Tăng Chí Thượng, deputy head of the department, told hospital directors to refrain from abuse of unnecessary high-tech treatments but to ensure quality. They were also told to prescribe medicine properly and follow the Ministry of Health’s protocols for hospitalisation, including the length of stays in hospitals, among others.

Mến said that hospitals should use software that is part of the health insurance assessment system to strictly manage their allocated funds.

The Việt Nam Social Security in the city would refuse payments to hospitals that abuse the fund and wrongfully charge for expenditures to cover insured patients, he added. — VNS


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