Police Uncover Cambodia Insurance Scam 赴柬旅遊稱染病 疑涉持不實收據申請理賠

Fraudulent National Health Insurance claims have come to light after 50 suspects have been arrested. They are suspected of using fake medical receipts obtained while traveling in Cambodia and claimed a total of nealy NT$ 8 million.


Taiwanese police traveled to Cambodia to find out if these medical receipts are real. The receipts were submitted by Taiwanese travelers to the National Health Insurance Administration.

Huang Chi-wei, 4th Investigation Corps, Criminal Investigation Bureau: “It started with contact with an overseas Taiwanese living there. Once the relationship was established, they asked their friends and family in Taiwan to travel to Cambodia. They would pay this overseas Taiwanese person cash for fake medical certificates and receipts from this overseas Taiwanese and then apply for claims from the National Health Insurance Administration and insurance companies after getting back to Taiwan.”

Police identified an insurance agent surnamed Chan as a central figure in the scam. In less than a year, 50 people collected over NT$7.78 million from the NHIA and insurance companies in this way. The NHIA lost NT$1.35 million with no recourse to recover the amount.

Lee Po-chang, Director-General, National Health Insurance Administration: “If you have an accident or fall ill while traveling overseas and need medical treatment, hospitalization or a visit to the ER, the national health insurance system will provide compensation in the amount that you would have had to pay if you'd been in Taiwan. It is wrong to use fake receipts to collect money from insurance companies.”

The scam was uncovered when police noticed many receipts coming from the same few hospitals in a short amount of time. The case has been transferred to prosecutors but the amount lost by the NHIA will be passed on to taxpayers. The administration says it will work with other agencies to improve vigilance.

 

 

 

員警遠赴柬埔寨,和當地醫院醫師一一確認情況,因為警方發現,有人趁著到國外遊玩,返台向健保署詐領理賠金。

刑事局偵查第四大隊第一隊副隊長黃祺瑋表示:「其犯罪手法,是先與柬埔寨當地華人聯繫,聯繫後,在台灣邀集親友,出境柬埔寨旅遊期間,透過該名華人以現金方式,購買偽造之診斷證明及費用收據,返台後再向健保署及各保險公司申請理賠。」

一張張醫療收據,病因大同小異。原來警方發現,一名詹姓保險業務員和多人合謀到柬埔寨旅遊,明明是開心出遊,卻聲稱在當地染上登革熱、發燒等等,開立不實住院收據,返台後申請理賠,50人近1年內向健保署和25家保險公司,詐保超過台幣778萬元,光是健保就損失至少135萬元。

健保署長李伯璋表示:「假如到國外去的時候,你萬一發生了一些意外,不管是門診或住院,或是急診的時候,在我們的健保裡面都有一定的規定,會比照在台灣生病的時候所給的給付,做一個核付,他假如不實的一個數據的時候,跟保險公司拿這樣的一個資源,這是不對的。」

海外就醫理賠件數,短時間內爆增,甚至看診醫院明顯集中,整起案件才曝光。全案訊後,警方依詐欺罪移送地檢署偵辦,不過詐保的不當利益,只好轉嫁全民負擔。健保署則表示,除了加強比對審查,也會透過跨機關合作,提升警示機制,避免再讓有心人,有可趁之機。

 

專題|全台敬老金大調查