Insurance fund rejects $132 million, citing fraud

May 26, 2017 | 08:17 AM GMT+7

The Việt Nam Social Insurance Agency rejected VNĐ3 trillion (US$132.2 million) in health insurance fees in the first four months of this year, the agency reported at a meeting held recently.

Insurance fund rejects $132 million, citing fraud
Social insurance reject expenditure due to fraud

The rejection was made after the agency discovered a range of violations such as health insurance card abuse, requests for multiple payments for one-time check-ups or requests to pay for medicines and medical services that are not covered by the agency.

Dương Tuấn Đức, head of the agency’s Inspection and Payment Centre in the northern region, said the violations were found thanks to the Ministry of Health and to the sharing database from the citizen health dossier system among the agency’s branches nation-wide.

The automated system has greatly helped the discovery of violations, he said.

The system uncovered health insurance card cheating, including the abnormal frequency of health insurance card use and the intentional prolonging of treatment in hospitals, he said.

The system reckoned that 2,776 people visited health facilities for examination and treatment over 50 times in the first four months of this year.

One patient in HCM City was found visiting 13 health facilities in the city for health examination and treatment a total of 57 times. It costs about VNĐ 40 million ($1,760).

Another was found visiting 15 health stations with 58 times, and sometimes he was given up to 300 pills each day.

Đức said, “If a patient takes 300 pills in a day, it’d be a miracle to survive.”

Additionally, many patients were found staying up to 7 days at Thanh Hóa Eyes Hospital after a lens replacement surgery. The same situation also happened in Sơn La Eyes Hospital and Thái Nguyên Eyes Hospital.

As normal, a patient only needs to stay 1-2 days at the hospital after that surgery, he added.

These violations have put pressures on the health insurance fund, he added.


Phạm Lương Sơn, deputy general director of the Việt Nam Social Insurance Agency, said the agency was considering suspending contracts with health facilities that abuse health insurance policies and revoking health insurance cards of users who abuse the cards.

The agency plans to set up inspection teams to check all health insurance payment at every locality soon, any violation would be strictly punished, he said.

In an article with Tuổi Trẻ (Youth) online newspaper, Bùi Đức Tráng, former head of HCM City’s Health Insurance Agency, suggested the agency establish an independent council to better manage the health insurance fund.

The council members would encompass representatives from the State, health sector, health facilities, health insurance users and employers.

It would manage the fund following regulations but in a flexible manner. For example, if the fund is over-expensed, health insurance users might be asked to pay more. If the fund had to cover fewer expenses, health insurance users could get more benefits, he said.

It is estimated that the percentage of Vietnamese citizens with health care insurance has reached 81.7 per cent so far.