Information exchanges will counter misuseof health cards

With fraud cases on the rise, the city is planning to make it as difficult as possible for social security scammers to bilk the medical insurance system in 2011.

In a bid to counter social security card fraud, the city will introduce three systems - a doctors' prescription database, a patients' billing database and an information-sharing system.

Yang Jing, a spokeswoman for the medical insurance department at the Beijing Human Resource and Social Security Bureau, said the systems should be up and running soon.

"We have enough regulations to manage social security cards' usage, but these systems are necessary to manage them technically," Yang said.

With the new systems in place, the bureau will be able to block abnormal expenses in a timely manner, Yang said.

In the half month between Dec 16 and Jan 5, the bureau became aware of 39 cases in which social security cards were used fraudulently. Those misused cards will no longer be usable.

The most common fraud that involves the cards is using them to buy expensive medicine, such as cardiovascular and cerebrovascular drugs, for people other than the card holders or even for sale to dealers.

More than 10 hospitals were found to have colluded in such scams last year. The hospitals were handed various punishments, including official warnings and the cancellation of qualification for social security cards.

A typical case of social security card abuse dates back to late 2009 when a man surnamed Wang borrowed nine social security cards from his relatives and then forged doctors' prescriptions to get medicine worth more than 56,000 yuan.

He was caught and sent to prison for three years.

As many as 8.25 million social security cards were distributed to local residents and workers in 2010. Some 94 percent of the total population are now thought to carry the cards.

The first of the cards were issued in September 2009. Since then, the cards have been used to buy 9.2 billion yuan's worth of medicine through the medical insurance system.

Unlike social security cards in Western countries, the card used in Beijing can only be used to spend medical insurance funds.

"It is just the first step," Yang said. "In the future, the card will be expanded to cover other social security services such as care for the elderly, social relief and community services."

The central government plans to issue more than 800 million social security cards during the period of the 12th Five-Year Plan (2011-2015), according to Hu Xiaoyi, deputy director of the Human Resource and Social Security Ministry. Hu explained the plan at a conference of the National People's Congress in December.

Before 2009, residents were issued a blue handbook that bore a barcode and that was effectively a medical insurance certificate. Under that system, people had to prepay their medical bills and apply for reimbursement at medical insurance offices after their treatment.

Yang said the card is better than the handbook because it avoids bills which were easier to forge.

The cards also mean patients no longer have to prepay their bills and the cards can be used to pay for services.

Card holders can use them to access treatment at almost 1,800 hospitals in the city.

Starting from Jan 1, residents will be able to use them for both outpatient services and if they are hospitalized.

"Residents are encouraged to report frauds they become aware of for cash rewards that can be as high as 5,000 yuan," Yang said.

"Medical insurance officers will also call at hospitals randomly to check medical bills to see if there are abnormalities, such as plenty of expensive medicines for one patient in a short time."