DOCTOR MASSIVELY DEFRAUDS NATIONAL HEALTH INSURANCE|醫療院所詐領健保費 去年高達2.2億元

Health care fraud has hit a record high. The National Health Insurance Administration found that the total amount of healthcare fraud was about NT$221.19 million last year. A well-known surgeon at Taoyuan's Ming-Sheng General Hospital, was found to perform self-paid bariatric surgeries and recorded them as other surgeries to defraud the National Health Insurance system and insurance companies. The total of health care fraud hits a record high. According to the NHIA, last year the amount of illegal health insurance claims was as high as NT$221.19 million, a record high for the past years. Some of the medical personnel or the public, together with insurance scalpers, claimed on the insurance with falsifying medical certificate and records. Hospitals then inflate the amount of health insurance. Lee wei-jie, a renowned bariatric surgeon at Ming-Sheng General Hospital in Taoyuan, was found falsifying bariatric surgeries, which are paid by the insured themselves, to surgeries like gastric ulcer, hiatal hernia. He claimed nearly NT$50 million and was under investigation. ==KAO SHIH-HAO, SEO, National Health Insurance Administration== If the insured pay at their own expense and you collect the money to claim on health insurance, this will be an illegal act. The NHIA found gastric ulcer cases are more than 20,000 in Taiwan for now, and the gastric perforation cases, which require operation, are just 1,200. Lee wei-jie alone has operated on 2 to 300 patients out of those cases. The NHIA said if the health care fraud is confirmed, the health insurance will be recovered and Ming-Sheng General Hospital will be fined 2 to 20 times the amount of its claims after the final verdict, while the Department of Surgery is likely to face suspension. ==LEE PO-CHANG, Director General, National Health Insurance Administration== After the suspension, Ming-Sheng General Hospital needs to continue serving the public. Because the public are covered by health insurance, the hospital can't claim on the health insurance. It has to pay the money by itself. The NHIA stressed the public and doctors hold responsibility for preserving the resources of health insurance. Medical professions need to discipline and if they make any health care fraud, the money will be recovered. Starting from this Oct., the NHIA is to introduce new measures to avoid excessive deletion of health insurance. It will take the initiative to inspect illegal acts. TRANSLATED BY：BRYANT CHANG 醫療院所詐領健保費金額創新高，根據健保署統計，違規申報健保金額，去年就高達2億2119萬元，是歷年最高紀錄，有些少數醫事人員或民眾勾結保險黃牛，以不實的診斷書與病歷，向保險公司申報理賠，再由醫院詐領健保給付，其中減重名醫桃園敏盛醫院外科醫師李威傑，被檢調查出他將自費的減肥手術、虛報為胃潰瘍、橫膈膜疝氣，詐領近5000萬元遭移送法辦。 ==健保署專委 高世豪== 跟保險對象有收到自費的錢 都來報健保申報上面來講 這是不正當的行為 健保署調查發現，全台灣目前胃潰瘍診斷病例雖然2萬多例，但引發胃穿孔等需要手術的只有1200件、李威傑一個人就佔了2、300件，健保署表示，如果證實醫師虛報，除了會向敏盛醫院追回健保費，等司法判決後，依法可再處2到20倍罰鍰，而且敏盛醫院外科恐怕會遭到停止特約。 ==健保署長 李伯璋== 停業之後這段時間 它(醫院)就繼續做服務民眾 可是因為我們的民眾都有健保 它沒有辦法跟民眾用健保費 它自己就吸收掉那個錢 健保署強調，維護健保資源，民眾和醫師都有責任，醫界也需要自律，只要浮報、虛報健保，就要吐回來，另外，從今年10月起開始推動專業雙審、試辦具名核刪新措施，避免過度放大核刪，日後也會主動查察不法。 記者 吳雅瑜 林國煌 台北報導