According to the National Healthcare Security Administration’s website, various healthcare insurance departments across China have stepped up their oversight of healthcare funds this year, implementing stringent measures to combat fraud and abuse. A number of notable cases of illegal use of healthcare funds have come to light, particularly from Liaoning Province.
**1. Issues at Kangda Hospital in Yingkou Economic and Technological Development Zone**
In September 2023, following tips from a provincial inspection team, an investigation was initiated into Kangda Hospital. The inquiry uncovered numerous violations, including duplicate billing, swapping of treatment items, charging inflated fees, conducting unnecessary tests, excessive medical procedures, fragmented hospitalizations, and including non-reimbursable expenses in settlements with the healthcare fund. As a result, the Yingkou Healthcare Security Bureau mandated that the hospital correct its practices, return 116,296.80 yuan in improperly used funds, and pay an administrative fine of 141,413.11 yuan. The hospital has since reimbursed all misappropriated healthcare funds and settled the fine in full.
**2. Problems at Beipiao Tonghe Hospital Co., Ltd.**
In October 2023, the Chaoyang Healthcare Security Bureau conducted an onsite inspection of Beipiao Tonghe Hospital Co., Ltd. The audit revealed issues such as charging above standard rates, duplicate billing, and the inclusion of non-reimbursable medical expenses in the healthcare fund. In accordance with relevant regulations, the bureau required the hospital to rectify its practices, return 83,773.19 yuan in improperly used funds, and imposed a fine of 108,905.15 yuan, which is 1.3 times the amount misused. All funds have been recovered, and the fine has been fully paid.
**3. Violations at Qinghe Kangseng Hospital in Tieling**
In March 2024, the Tieling City Qinghe District Healthcare Security Bureau, while investigating cases transferred from the Tieling Healthcare Bureau, identified violations at Qinghe Kangseng Hospital. From November 19, 2021, to December 31, 2022, the hospital engaged in excessive billing and unnecessary treatments that contravened medical norms. The bureau’s actions included warning the hospital’s leadership to rectify the situation, demanding the return of 19,776.61 yuan in misused funds, and imposing a fine of 25,709.59 yuan, at 1.3 times the amount misused. The hospital has returned all wrongly used healthcare funds, and all fines have been paid.
**Editor: Ye Pan**
About the author