Clinics closed over fraudulent claims

Clinics closed over fraudulent claims

The Department of Health Service Support yesterday ordered the temporary closure of two Bangkok medical clinics for allegedly defrauding the kingdom's universal health care service.

"These clinics are found of falsifying financial claims from the universal healthcare scheme," Thares Krasnairawiwong, director-general of the department, told media yesterday. "In reality, they did not provide the health services stated in reimbursement forms."

The closure of the two unnamed clinics is expected to last 30 days, and the operators are to be charged with violating the 1998 Health Facility Law.

A total of 86 medical clinics in Bangkok and surrounding provinces are being investigated by the ministry of public health and National Health Security Office (NHSO) for allegedly making false financial claims through various health care schemes.

NHSO -- a state body that oversees healthcare budgeting, this week completed its initial probe and found 80,000 patient names have been unlawfully used by scores of clinics.

Private clinics have received subsidies to provide free health checks on common ailments like diabetes and high blood pressure for the public since 2010. NHSO allocates about 250 million baht per year to feed the scheme.

Previously, the NHSO categorised the scheme as part of the kingdom's universal healthcare package. Reimbursements were supposed to account for individual patients, but due to a lack of public interest, the office changed the rules, so payments are now made based on the number of people accessing the service.

The policy represented a loophole as some private clinics use any patient's name to receive reimbursements.

"We have found at least 80,000 names [used] in false claims cases," Karoon Kuntiranont, deputy secretary-general of NHSO told a press conference on Thursday.

"The office is going to put those names on a website shortly so the public can check whether their names were illegally used," Dr Karoon added.

Dr Karoon noted the names were given an "inactive" status to prevent others from fraudulently claiming medical benefits. The NHSO will "reactivate" the names if people come forward and inform NHSO officials. According to the NHSO's initial examination, the two clinics', using "ghost" names, caused financial damage of approximately 70 million baht.

In its investigation, the office said it made calls to check 3,264 people and found 224, or about 7%, never received medical services.

To prevent any potential fraud in the future, the Public Health Ministry is drafting additional ordinances which include the need for the digital authentication of a patient.

Nimit Tienudom, a committee member of NHSO and also its spokesperson, admitted the false claims hurt the public image of the kingdom's universal healthcare scheme.

"This case involves the largest number of victims that we have ever seen, which has destroyed the credibility of the office and medical sector," Mr Nimit said.

"However, [the investigation into] the case has demonstrated our efficiency in the examination procedure," he added.

Apart from the 86 medical clinics, the NHSO said it is going to inspect 202 others in the capital and its nearby provinces.

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