Former head of Cardiology Department in Quang Nam sentenced for health insurance fraud

Defendant Nguyen Tan Ba ​​(50 years old, residing in Tan Thanh ward, Tam Ky city) was sentenced to 2 years of suspended prison for “Cheating on health insurance”.

Besides, the jury also sentenced defendant Nguyen Van Son (31 years old, residing in Nui Thanh town, Nui Thanh district) and Luong Thanh Trung (36 years old, residing in Tam Xuan 1 commune, Nui Thanh district, Quang Nam). 1 year suspended prison for the same crime as defendant Ba.

In addition, the jury imposed a fine of VND 30 million on defendant Nguyen Thi Hong Hai (former head of assessment of social insurance in Quang Nam province at Quang Nam Central General Hospital) VND 30 million, banning the defendant from performing the task of assessing health insurance for a period of time. term of 1 year; Defendant Pham Thi Bich Tram (former deputy examiner) 40 million VND, banned the defendant from performing health insurance duties for 1 year. These two defendants were charged with the same crime of “lack of responsibility, causing serious consequences”.

According to the indictment, defendant Ba directly examined, consulted and conducted coronary angiography, performed stenting procedures for treatment patients; During the examination and treatment, defendant Ba knew that 22 patients had mild coronary artery stenosis and did not need a stenting procedure.

However, for personal purposes, defendant Ba directed Trung and Son to be nurses of the department, making false records of these 22 patients to appropriate stents, attached supplies and equipment, which were provided by the hospital to the Internal Medicine department. Cardiovascular treatment of patients.

Then, transfer the faked file to the Finance – Planning Department of the hospital to summarize and pay for health insurance with the Quang Nam Provincial Social Security.

“The defendants’ actions caused damage to the Health Insurance amount of VND 829,607,208, and a loss of VND 162,233,287 to the hospital,” the indictment states.

For defendant Hai, during the process of examining the medical records, paying for coronary angiography and placing stents, he did not direct the examination of images stored on the Pacs system to determine whether the hospital performed the procedure. stent for the patient or not, but agreed to ask the Quang Nam Social Security Administration to pay for 5 medical records made by defendants Ba, Trung and Son, causing damage to health insurance in the amount of 202,535,000 VND.

Meanwhile, in the process of assessing the medical record, requesting payment for coronary angiography and performing the procedure of placing the hospital’s stent, defendant Tram only viewed images of coronary angioplasty, before and after images. stent placement on file.

These images do not show the patient’s name, time of procedure, but the defendant did not compare the images stored on the hospital’s Pacs system with the medical record, causing damage to Insurance medical amount 202,535,000 VND.

Cong Sang