The Vietnam Social Security said that, since the establishment of the Health Insurance Inspection Information System, Vietnam Social Security has regularly reviewed medical information about the insured’s participants on the System and has found many cases with signs of axis. benefits of the health insurance fund.
Vietnam Social Security resolutely warns and strictly punishes cases of profiting from the health insurance fund to ensure the rigor of the law.
Vietnam social insurance industry has issued a written warning and requested the health sector to direct medical facilities across the country to review and inspect these cases. The results showed that, in addition to the cases of sudden increase in the number of curative care visits due to illnesses and prescribed by doctors, there are still many cases with an increase in the number of medical services due to the act of profiting from the health insurance fund. For the case of profiting from the health insurance fund, the social insurance agency has coordinated with the health sector to promptly handle the case according to regulations.
Recently, through updated data on the Inspection Information System of Health Insurance and Social Insurance in Ho Chi Minh City, patients have been found in the city. Ho Chi Minh City went to health insurance for many times, showing signs of profiting from the health insurance fund. Thereby, the city social insurance. Ho Chi Minh City has notified the Department of Health and some medical facilities about this content and proposed to coordinate review and inspection.
Specifically, patients with NTK in the city. Ho Chi Minh City, registered initial health care medical insurance at Trieu An Hospital. From January 1 to March 8, 2021, this patient had 80 times of medical examination and treatment under the health insurance, the total cost of the health insurance fund to pay for this patient was more than 60 million VND.
Patient K. registered for medical examination and treatment under health insurance at 18 different hospitals in the city. Ho Chi Minh City: Go Vap Hospital (17 times), Hospital District 7 (11 times), Thu Duc Hospital (10 times) …
Director of HCM City Social Insurance. According to Ho Chi Minh, Phan Van Men, in addition to promptly sending warning information to the Department of Health and medical facilities about the signs of profiting from the health insurance fund of patients with the patient to avoid abuse and profiteering of the fund. Health insurance; City Social Insurance. Ho Chi Minh City also asked the Department of Health to continue directing medical facilities to promptly transfer data to the receiving portal right after the end of the examination, or the end of the outpatient and inpatient treatment of patient; Facilities that do not incur medical costs of health insurance insurance during the day must comply with the correct data transfer regulations.
Right in the morning of March 24, 2021, City Social Insurance. Ho Chi Minh transferred the file to the police to investigate and clarify the case in order to promptly warn participants to strictly abide by the law on health insurance.
Mr. Phan Van Men also emphasized: In the current legal documents on health insurance, there are no regulations that limit the number of times of medical examination by participants. In fact, not all cases of sudden increase in the number of health care services covered by health insurance are also profiting from the health insurance fund. For example, for cases of chronic diseases, … on the basis of the patient’s pathology, according to the doctor’s instructions, the patient can increase the number of medical services covered by health insurance many times a year.
But at the same time, through the Health Insurance Inspection Information System, there are cases of patients with a sudden increase in the number of medical check-ups; These cases, through examination and review, showed signs of profiting from the health insurance fund. For these cases, it is necessary to firmly warn and strictly deal with the regulations, to ensure the legitimate rights and interests of the insured and the strictness of the law – Mr. Phan Van Men affirmed.
Le Kim Lien