Doctors' licenses revoked for NT$80 mil. insurance fraud

The scandal yesterday rocked the medical community when the Department of Health (DOH) revealed that a syndicate of medical personnel has been falsely diagnosing conspiring “patients” with cancer - going as far as performing breast removal surgeries and chemotherapy on disease-free bodies - since 2003 to file multiple insurance claims.

The DOH estimated that more than 10 hospitals are involved. Three doctors have been formally charged and seven suspects are being investigated in their role as fake patients; for the first time, the DOH has invoked the heaviest penalty by revoking the doctors of their licenses so that they may never practice again.

According to DOH Minister Yuang Chin-liang, the individuals include: Yang Chao-jan of the health department's own Keelung Hospital, Lai Teh-hsing of Taoyuan's Yee Zen General Hospital as well as Wu Kuo-ching of Yunlin's St. Joseph Hospital. The amount of insurance fraud has reached NT$80 million. In accordance with the Physician's Act, all subjects were stripped of their doctor's certificate as punishment.

The accused doctors colluded with a fraud ring headed by a man identified as Fu Chien-sen, who since 2003 has orchestrated fake medical treatment records with doctored diagnoses and surgery reports to claim cancer payments from life insurance companies.

“The trick was using fake diagnoses and surgery reports as well as samples stolen from cancer patients to make the fraudulent insurance claims,” Yaung noted.

Furthermore, the group allegedly diagnosed seven “patients” with cancer of the breast, colorectal, uterus, ovaries or other areas as a front to collect insurance costs. Most appallingly, doctors went ahead and performed operations as if the diagnoses were real; of the seven people, four “patients” had their breasts removed and two others underwent chemotherapy. Fu himself had hemorrhoids removed and received an operation on his rectum.

According to Shih Chung-liang, director-general of the Bureau of Medical Affairs, insurance companies first became suspicious when people became “cancer-ridden” soon after they were insured. Many of the patients also hadn't completed the entire course of cancer treatment. When the companies sent employees to visit their “sick” clients, they found them healthy and “jumping around,” apparently not suffering from anything too severe.

The Criminal Investigation Bureau (CIB) initially sent four teams to investigate the syndicate headed by Fu for insurance fraud and was surprised to discover that medical personnel of all levels in over a dozen public and private hospitals were in on the conspiracy.

Shih said this is the first time that doctors were found to cause intentional, grievous bodily harm to patients.

Even if considering the patients themselves were involved in the fraud, Shih argued that the doctors still committed a crime of a most serious nature, hence the revocation of the doctor's certificate and lifetime guarantee that the prosecuted will never again serve as physicians.

According to the CIB, this pattern of fraud has been operative since as early as 2003, with a tally of over 10 hospitals involved. In addition to the aforementioned three doctors, four are currently under investigation. Yuang said that while the probe is not public, if it is determined that other doctors are involved, the prosecution will charge and expose all of them without leniency.

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