Cho Ray Hospital doctor arrested for insurance scam

The police have arrested a doctor at a major Ho Chi Minh City hospital and a pharmaceutical company representative for allegedly using health insurance documents to issue fake prescriptions and cash in on the drugs. 

Dr. Luu To Lan, 41, of the Cho Ray Hospital’s endocrinology department and Luu Thi Lieu, 26, employee of Nhat Tien Pharmaceutical Co. Ltd. in HCMC are likely to face charges of “abuse of power,” the police of the Ministry of Public Security said Friday.

 

The Supreme People’s Procuracy, Vietnam’s highest prosecution body, will consider ratifying the charges.

 

The ministry’s Bureau for Graft Investigation (C37B) found Lan having issued more than 1,040 prescriptions for health insurance policyholders with addresses in HCMC and nearby provinces between January and April 2009.

 

The value of these prescriptions was VND3.536 billion (US$198,763), of which VND3.358 ($188,757) would be refunded by the health insurance companies.

 

Police said 916 of these prescriptions were issued improperly. For instance, they did not show the number of the examination room because no patient had actually been examined.

 

Patients wait to get medicines at the pharmacy in Cho Ray Hospital

These wrongfully issued prescriptions were for drugs valued at more than VND3.277 billion ($184,194), police said. Of this amount, the insurance agency would have to refund VND3.12 billion ($175,370) and the rest was supposed to be paid by policyholders.

 

Lieu colluded with Lan in committing the crime by offering documents of health insurance policyholders, police said.

 

Inspections of Lan’s workplace and residence on Friday found several documents relating to the case, police said.

 

C37B police are investigating the case further.

 

Cho Ray Hospital statistics show an average of 3,000 outpatients are examined every day, 800-900 of whom are health insurance policyholders.

 

Late last month, the Ho Chi Minh City Social Insurance Agency said it has evidence a Cho Ray Hospital doctor may have surreptitiously used its policyholders’ information to issue fake prescriptions and collect the drugs from the hospital.

 

A source at the hospital said the case was originally reported by another Cho Ray doctor, who had seen suspicious signs and secretly observed the alleged culprits to find on May 8 that Lan had issued up to 25 fake prescriptions.

 

Nguyen Truong Son, director of Cho Ray Hospital, admitted Friday responsibility in failing to detect and prevent the violations. Earlier, the hospital had suspended Lan after the media exposed the case.

 

He said there were “more than two employees” when answering Thanh Nien on whether there was a ring involved in the scam.

 

Social Insurance Agency Director Cao Van Sang said Friday that similar scams could have happened at other medical facilities.

 

“We will work with the city’s Health Department to find preventive solutions to the issue of doctors and medical workers committing such frauds,” he said.

 

When the case was first detected, Sang said they had found that the doctor, then revealed only as L., had issued 33 prescriptions in two days last month. Sang said the prescriptions were valued at more than VND3 million ($169) on average.

 

Most of them were medicines for diabetes, blood disorders and kidney failure, all problems that generally affect the elderly. But Sang said those who received the prescriptions, according to office paperwork, were young people.

 

Cho Ray Hospital, which was established in 1900, is one of the three large hospitals that the Ministry of Health has invested in to become a full-fledged general hospital, according to the hospital’s website.

 

The hospital, directly managed by the Ministry of Health, has a staff of 2,270, including 500 doctors and pharmacists, who treat an average of more than 457,000 outpatients and about 67,000 inpatients per year.

 

VietNamNet/TN