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Wuxi hospital probed for insurance fraud

Authorities launch citywide inspections after reports of falsified medical records

By WANG XIAOYU | China Daily | Updated: 2024-09-24 09:57
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Police in Wuxi, Jiangsu province, have launched an investigation into a hospital suspected of falsifying medical records to claim insurance payments as the nation's top healthcare insurance authority said it has rolled out inspections across hospitals in the city.

The National Healthcare Security Administration said on Monday that it dispatched an unannounced inspection group to Wuxi Hongqiao Hospital following news reports that it had been fabricating imaging test results for nonexistent patients to dupe the public insurance fund.

"The administration has also guided healthcare security authorities in Jiangsu to send 20 groups to carry out comprehensive inspections of over 100 insurance-designated medical institutions in Wuxi," it said in a statement.

Also on Monday, Jiangsu's provincial Healthcare Security Administration said in a separate circular that the medical insurance service agreement with the hospital had been terminated.

Police have begun investigating the case, and related personnel from the hospital have been placed under control, it said.

Wuxi Hongqiao Hospital is a privately owned hospital in the second tier of China's three-tier hospital system. It has 160 hospital beds and more than 500 staff members.

According to a report released by China National Radio on Saturday, a radiologist at the hospital found a number of medical records that contained radiological diagnoses but lacked key information such as imaging test bar codes and radiographic images. Most were written by a doctor in the hospital's physical examination department who was not involved in any radiological work.

The radiologist took pictures of 99 medical records created from around July 2022 to April 2023 that belonged to patients age 60 to 80.

In March, the radiologist made a report to hospital managers and found more irregularities in the following months. They included identical-looking CT scan images from several patients and two magnetic resonance imaging examinations that were carried out only one minute apart, while one session normally takes at least 10 minutes.

The National Healthcare Security Administration pledged to adopt a zero-tolerance attitude toward medical insurance fraud and said it will punish violators more severely.

Yan Qinghui, its deputy director, told a news conference this month that the administration has stepped up regular and unannounced checks in recent years as part of efforts to crack down on fraud.

It has inspected 432 insurance-designated hospitals in 30 provincial-level regions, and the number of hospitals inspected this year is expected to exceed the total over the past five years.

The administration has also deployed big data tools to improve work efficiency and told medical institutions to examine themselves.

It has also set up a reward mechanism for whistleblowers, with a total of 3.68 million yuan ($576,000) in rewards issued for 2,422 tip-offs since 2022.

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