Cousin of Chinese spouse bilks Taiwan National Health Insurance out of record NT$900,000

Taiwan taxpayers bilked out of NT$900,000 after Chinese spouse lends health insurance card to cousin

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(CNA photo)

TAIPEI (Taiwan News) -- Taiwan taxpayers were cheated out of a record NT$900,000 after a Chinese spouse lent her cousin her National Health Insurance (NHI) card to cover cancer treatment bills, announced the National Health Insurance Administration (NHIA) on Monday (July 29).

Lee Po-chang (李伯璋), director of the Central Health Insurance Department of the Ministry of Health and Welfare, on Monday said that the biggest NHI fraud case occurred last year, when a Chinese spouse lent her insurance card to a cousin suffering from gastric cancer, reported UDN. The patient used the card to cover all of her costs for hospital care and surgery, which totaled NT$900,000 (US$28,000).

It was not until the doctor was preparing to issue a death certificate in the original card owner's name that she confessed that she had lent it to her cousin. After an investigation, the cardholder was sentenced to four months in prison, given two years' probation, and was also charged for all of the medical costs her cousin had incurred during her treatment in Taiwan.

Lee said that according to statistics, 35 cases of fraudulent use of health insurance cards have been reported since 2014, reported Liberty Times. Most of the cases have been reported by members of the public, healthcare personnel, the National Immigration Agency, and police investigation units.

The total losses from the fraud cases have reached an estimated NT$1.75 million, resulting in NT$1.08 million in fines, reported UDN. Further analysis has found that 19 of the fraudulent claims originated from foreign nationals, including two Chinese spouses of Taiwanese citizens, reported CNA.

Meanwhile, 16 fraudulent users were Taiwanese, most of whom were fugitives trying to avoid detection and posing as others while seeking medical treatment. Lee said that other fraud cases have ranged from hundreds to tens of thousands of Taiwan dollars.

Although these all constitute acts of fraud, many cases are not prosecuted or are postponed because the amount is relatively low. NHIA Underwriting Division official Wu Hsin (吳昕) said that most fraud cases were perpetrated with cards lacking a photo on them, according to CNA.

Although a new regulation went into effect requiring all new applications for and replacements of NHI cards include a photo ID, about 20 percent NHI cards still do not include pictures of the holders, said Wu. Recently, hospitals have been notified by the agency to ask patients to provide another form of identification if their NHI card does not have a photograph.

In addition, Lee conceded that the health card insurance fraud problem cannot be solved by big data analytics. He said that even if doctors find patients using other people's NHI cards fraudulently, because they have not received any treatment, it does not count as a criminal act, so he suggested the cases reported are just the tip of the iceberg.

According to the National Health Insurance Act (全民健康保險法), the agency can refuse to reimburse medical costs incurred if a hospital does not verify the identity of a patient. If a hospital knowingly admits a patient who is using another person's NHI card, the agency can impose a fine of 20 times the cost on the facility.