Stop insurance fraud at hospitals

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Stop insurance fraud at hospitals

Health authorities have released the names of 14 hospitals, dental clinics, Eastern medicine clinics and pharmacies that have doctored their books or counterfeited documents in order to get more funds from public health insurance programs. These shady medical institutions pocketed 680 million won ($617,000) by tampering with their health care and patient records.

It turns out that they overcharged patients and institutions between 15 million won and 200 million won. The 14 medical facilities were the worst among 219 health care institutions that incurred administrative penalties for submitting bogus medical bills to the National Health Insurance Corp. from last August to February.

Their unethical practices are beyond comprehension. An Eastern medical clinic in Busan, for instance, even fabricated records to turn one treatment into 124, pocketing a total of 205 million won over the last 20 months. Fraudulent and bogus medical bills eat up the government’s public health insurance fund and end up increasing its insurance burden, which is then borne by taxpayers.

As a matter of fact, the NHIC incurred a deficit of more than 1 trillion won last year and has already used up this year’s reserves of 960 billion won. The public insurance program is running short of funds to finance its health care coverage and what little is left is being stolen by immoral health organizations.

Last year, the authorities penalized and disclosed the names of 13 medical entities. But the practice has not been rooted out because the penalties were too soft. Under the public health insurance law, the authorities can suspend, or penalize, the clinics and institutions that submit fraudulent medical bills.

The authorities are authorized to release the names of the facilities and can also suspend doctors and pharmacists for a certain period of time. The Ministry of Health and Welfare has demanded that the over payments be returned, suspending the operations and licenses of the 14 facilities for between 66 and 184 days. But after the suspension period is over, their business will return to normal, and doctors and pharmacists may believe they can borrow a license as long as they want to continue their medical practice.

The health authorities should regard such bogus practices as a serious crime and take the necessary action. They should increase the administrative fines as well as penalize the act as insurance fraud with a heavy sentence. If the punishment is strong enough, other institutions will come to be afraid of breaking the law.
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