End illegal deals between patients and doctors

A Chinese doctor talks with family members of a young patient as he examines him with a Type-b Ultrasonic Diagnostic Instrument at a hospital in Beijing, China, 11 September 2013. [Photo/IC]

MORE THAN 1.5 BILLION YUAN ($218 MILLION) was misappropriated from the medical insurance fund last year, according to a report released by the National Audit Office. Beijing News commented on Wednesday:

The National Audit Office report outlined 180 cases in which doctors and patients conspired to swindle the country out of over 200 million yuan by forging hospitalization records and having non-existent treatment costs reimbursed by the medical insurance fund.

Such collusion is deceptive and not easy to track. In other words, it is almost impossible to nip such medical fraud in the bud, and there might be yet more such fraud that remains undiscovered.

What really makes the illegal alliance between patients and doctors seem unbreakable is that they are on the same side when it comes to "picking up windfalls" from the public fund.

By co-sponsoring such scams hospital-goers do not have to pay for drugs at all as long as they are masked as prescriptions covered by medical insurance, and some hospitals could have more in their pockets by forging medical records.

However secretive it may be, such conspiracies to defraud will gradually come to light when stricter supervision is in place. Whether the purchase and prescription of drugs add up or not, for instance, should not be too difficult to find out. Other dubious events such as repeated treatments in a short time, too, must be scrutinized closely.

Of course, medical staff should be included in the supervision as they possess the necessary medical knowledge to unearth medical fund fraud. They have the professional knowledge to recognize which drugs are necessary for patients and which are not, enhancing the likelihood of keeping fraud at bay.

The fundamental cure still lies in an overhaul in the use of medical insurance fund, which covers beneficiaries' cost on the basis of specific programs instead of their illnesses.