109 suspects indicted in health insurance fraud case

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Taipei, Aug. 11 (CNA) Taipei prosecutors on Thursday indicted 109 suspects in a medical insurance fraud case that allegedly involved Dianthus Medical Group, some of its patients and several insurance sales agents.

The suspects charged with fraud and forging documents included Dianthus Medical Group CEO Lin Tzu-hung (林思宏), four doctors and other medical personnel employed by the company, and 19 insurance agents, the report said. Taipei District Attorney’s Office.

In addition, 80 mothers who had been patients at Dianthus were among the 109 people charged in the medical insurance fraud case, prosecutors said.

According to the Dianthus website, the group currently operates 12 clinics in Taiwan – 10 in Taipei and two in Taoyuan – specializing in maternal-fetal medicine (MFM), gynecology, obstetrics, pediatrics, dentistry and ophthalmology.

Prosecutors said they launched an investigation into the medical company’s operations after Hontai Life Insurance reported earlier this year that it had found discrepancies in numerous claims filed by Dianthus patients.

The claims, which were specific to five Dianthus clinics, were based on false medical information, in an attempt to obtain private insurance reimbursements, prosecutors said.

For example, they said, women allegedly made insurance claims for unavoidable caesarean (caesarean) deliveries when, in fact, they chose to give birth this way, prosecutors said.

Insurance claims falsely cited birth complications such as “fetal malpresentation” that required caesarean section surgery, prosecutors said.

The 19 insurance sales agents charged Thursday allegedly colluded with Dianthus in such cases in an effort to win customers, prosecutors say.

The case involved 10 insurance companies, and the proceeds from the alleged fraud and forgery amounted to some NT$67 million (US$2.23 million, according to prosecutors).

On Thursday, the Taipei District Attorney’s Office said it would demand severe punishment for Lin and the four other doctors involved in the case, because they had tarnished the reputation of doctors and the health insurance system at the national scale.

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