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Clinic checks defended after criticism

By Chen Hong (China Daily)
Updated: 2009-11-17 10:43

SHENZHEN: The city's social security fund management administration Monday refuted a report on its alleged improper entrapment practices in supervising the local medical institutions, claiming that its efforts are only meant to ensure the safety of the huge medical insurance fund.

Southern Metropolis Daily reported Monday that supervisors from the administration pretended to be patients and set traps for doctors and other medical staff in a couple of community healthcare centers. As a result, the centers were fined or had their qualifications to receive patients with medical insurance suspended for three to 12 months.

The traps included the supervisors appearing at the healthcare centers, pretending to need emergency care, showing medical insurance cards of other people, whom they resembled. The doctors on duty later said the entrapments were unfair, as they had no time to check the information on the medical insurance cards.

The report is not "based on fact," and the administration has the right to check on the goings-on at the clinics, Huang Xianfeng, spokesman of the administration, told reporters after the Southern Metropolis Daily report.

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"We are a third-party supervision organization to the medical institutions, commissioned by the insured," Huang said. "We are empowered to check whether the medical institutions are providing services in conformity to the contracts, and whether they are using the public security fund properly. We are allowed to do on-the-spot investigations and secret inquiries."

A medical institution failing to verify a patient's medical insurance card alone would not lead to any punishment, according to the contract signed between the administration and medical institutions.

"We will give a report to the medical institutions about their malpractices and allow them to make responses before making any penalty decision. If disputes arise, both parties can go to the local arbitration commission," Huang said.

All fines will go directly to the social security fund, and the bonus of the supervisors is not connected to how many hospitals were fined, he added.

Seven medical institutions, including the one exposed in the report, received punishments ranging from a three- to 12-month license suspensions in August due to serious violations, according to the administration.

"They charged the patients much higher than the market prices of the medicine, which means they were stealing money from the insured. It's definitely unacceptable," Huang said.

In the most serious case, a clinic charged nearly 15 times the normal price of the medicine.

The administration has punished 89 medical institutions since its establishment, exposing more than 10 million yuan of overcharges from the social security fund, according to official figures.