The National Healthcare Security Administration on Monday has initiated a special investigation into Wuxi Hongqiao Hospital in Jiangsu province in response to recent online allegations of insurance fraud at the hospital.
The hospital's medical insurance service agreement has been terminated in accordance with regulations. The local public security department has opened a case for investigation, leading to the detention of several individuals at the hospital.
近日，江苏省无锡虹桥医院放射影像科朱医生实名反映，从去年开始，医院系统内出现了一些根本没在他们科室做过影像检查的患者病历，病历记录里却有“根据影像做出的诊断”。这些病历全都由医院体检中心陈医生完成，而这名医生并没有操作放射影像科CT、核磁共振仪的权限。
A doctor surnamed Zhu from the Radiology Imaging Department at the hospital has raised concerns about a suspicious situation. Since last year, the hospital's system has been recording medical records for patients who apparently never underwent any imaging tests in his department. Strangely, these files are indicating "diagnoses based on imaging."
What's peculiar is that all these records were approved by a doctor surnamed Chen from the hospital's health check-up center, who lacks the authorization to operate the CT or MRI machines in Radiology. Zhu suspects foul play, suggesting that the hospital could be fabricating medical records to defraud the medical insurance system.
因此朱医生怀疑医院涉嫌伪造病历，骗取医疗保险。今年3月，他将没有影像号的病历拍照留证，向医院上级管理部门实名举报。在等待调查结果时，他举报的这些病历又有了影像号和片子。
根据朱医生提供的放射影像记录显示，72岁的杨某某、62岁的邱某某与25岁的叶某，三人的片子几乎一模一样。通过医院系统查询还能看到，有患者在正常做核磁共振检查之后1分钟内，另有患者做了核磁共振检查，而正常检查至少要花10到15分钟。
记者随机拨打了20份病历中留下的患者电话，四分之三是空号或无法接通，接通的也大多表示不是本人。
72岁的杨某某、62岁的邱某某与25岁的叶某，三人的片子几乎一模一样
诸多事实表明，该医院可能存在造假骗取医保资金的行为。
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