A whistleblower's report about the massive pharmaceutical fraud involving government officials and medical staff at the Veterans General Hospital shows the need to investigate claims filed with state medical facilities, especially in light of the ballooning medical welfare budget.
The controversy has left many people in disbelief -- how could the director and executives at VGH allow such a practice to take place for almost a decade? In fact, if whistleblower Patchani Phunsuk hadn't gone public with her investigation, the pharmaceutical scam would have continued without anyone noticing.
Ms Patchani, the wife of a soldier who lives on a military base in Lop Buri, became aware of the scam after she was urged by a member of a criminal network to join its team of fake patients, who would be sent to the VGH to ask for expensive, imported medications that would be resold at pharmacies in Bangkok and Chon Buri at inflated prices.
In total, she spent 21 months investigating the network. She also managed to convince some of the fake patients to help the police investigation.
It is truly mindblowing that the prime suspects in the case are medical staff at the hospital, which is under the supervision of the Ministry of Defence.
Kanyarat Jitprasong, a retired colonel who worked as a nurse at the VGH, was accused by the police of channelling fake patients from Lop Buri to Dr Barinda Ujwatee, who would prescribe large amounts of medications for made-up illnesses.
Dr Barinda was said to be responsible for nearly 29% of all drug orders at the hospital over the past seven years, causing about 60 million baht in losses.
The police and the National Anti-Corruption Commission are also looking at another claim of fraud at VGH. A former executive at the hospital is said to have illegally used the ID cards of active-duty soldiers to fabricate medical records to make false claims for expensive medications that would be resold in the black market.
While the investigation is ongoing, the Ministry of Public Health and the Comptroller General's Department must come up with a way to verify the validity of claims filed with state hospitals to stem losses from fraudulent practices.
Some ministries, including the Ministry of Defence, treat the expanded benefit as a reward for public service. The medical coverage for government officials is considered to be among the most generous when compared with other state health insurance schemes. For example, the government's per capita spending stands at 3,800 baht for Gold Card scheme subscribers, 4,900 baht for Social Security Fund members, and 12,000 baht for Department of Local Administration (DLA) beneficiaries. The figure for civil servants, meanwhile, is 18,000 baht per person.
Currently, the government is studying ways to reduce inequalities in the medical welfare system. There are many proposed options, such as merging some funds or even demanding some co-payment or even pre-payment.
Before making any substantial changes, the government should work towards preventing exaggerated and false claims in the system. Officials -- especially veterans -- must get decent welfare cover. Yet the claims must be valid and reasonable.
Fraudulent and exaggerated claims will only widen inequality and drive the country's medical welfare system towards bankruptcy.
The case of accused medicine embezzlement at the Veterans General Hospital brings much needed spotlight to the issue of exaggerated or even false claims that increased state medical welfare budget.
The case raises question on whether state hospitals have any guardrail to prevent false or exaggerated declare.
This controversy poses many questions on how the state hospital lets such an irregularity to go on for seven years. It must be said that the accused pharma scam would have continued unabated if a courageous a whistleblower Patchani Phunsuk turned blind eyes.
Patchani --a wife of a solider who lives in military camp in Lop Buri indeed was approached by this network to join its fake patient team in Lop Buri province. These fake patients will get 10% shares for going to hospital and even fake serious illness, in order to get medicines --most of which pricey imported such as diabetic medicine cost 300 baht per tablet, to resell to pharmaceutical shops in Bangkok and Chon Buri province.
It is shocking the accused mastermind is a high-ranked medical doctor and some staffs. It is reported that the arrested MD had approved 11 million tablets worth 80 million baht to fake patients --or 1/3 of medicine claim from VGH in Lop Buri. The police is conteplating whether to levy human trafficking charge as fake patients are told to eat unhealthily to subsitantiate their poor health.
The accused scam has been exposed after the whistle blower spent 21 months collecting information to police.
The case raises questions whether the accused scam is exceptional case or pattern that can happen elsewhere. With lax enforcement, it would not be preposterous at all, if pharma fraud repeats elsewhere.
Police and NACC are probing another fraud at VGH --this time involved former executive of the same hospital use ID cards of eligible soldiers to fabricate medical records to make false claims.
The question is how director-general of hospital does not observe any irregularity. In the controversy, the arrested medical doctor had been faced disciplinary probe and moved to inactive post because VGH however could not find tight evidence.
This pharma scam is enough for the ministry of public health and The Comptroller General's Department to launch investigation and invent enforceable monitoring measures to detect irregular claims.
Indeed, accused frauds adds weight to criticisms against medical welfare for officials. Among all four healthcare funding system in the country, medical benefits for officials is considered the best. per capita expenditures vary for each service model: 3,800 baht for the gold card scheme, 18,000 baht for civil servants, 4,900 baht for SSF members and 12,000 baht for DLA beneficiaries.
Some ministries such as ministry of defences also provides extra medical benefits. Indeed, welfare for soliders and armed-forces are considered even better.
Other three are three are the universal healthcare scheme (gold card), the Social Security Fund (SSF), and the Department of Local Administration's (DLA) health services.
Make no mistake, officials --especially veteran officials must get decent welfare. Yet, the claim must be valid and rationale. Frauds and exaggerated claims will only widen inequality and drive the country's medical welfare to more instability.
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