A Chinese government probe into the country’s health system has found that some hospitals are regularly making pointless and sometimes absurd insurance claims, from gynecological treatments for male patients to prostate checks for women.

China’s National Healthcare Security Administration revealed over the weekend that it had uncovered thousands of examples of health providers claiming for gender-specific medical procedures performed on patients of the opposite gender.

The investigation is part of a wider anti-corruption campaign targeting the health sector, which has uncovered issues relating to insurance fraud involving collusion between patients, doctors, and criminal gangs.

The regulator identified more than 4,100 cases of male patients being billed for gynecological procedures, including hysteroscopies and cervical cancer screenings. These incidents involved at least 30 hospitals in more than 10 different provincial-level regions, officials said.

The claims are being made for a variety of reasons. In some cases, doctors appear to be allowing women to claim for treatments using their husbands’ insurance, as full-time mothers often don’t have health insurance.

In other instances, hospitals are falsifying claims in order to claim extra reimbursements from insurance funds. More than 1,600 cases involved one hospital in central China’s Hunan province that routinely mischarged patients receiving anesthetics for gastroscopies.

Rather than billing patients for the anesthetics — which cost 75 yuan ($10.50) and aren’t covered by health insurance schemes — the hospital would instead say they had received a transvaginal ultrasound scan, which is a reimbursable treatment costing 450 yuan.

Meanwhile, a large number of hospitals are charging female patients for male-specific procedures. The administration stated in another report also released over the weekend that investigators had uncovered nearly 13,000 such cases, which often involved hospitals overcharging women for pointless tests.

One hospital in the northeastern Jilin province reportedly marketed a cancer screening package that led to more than 200 women being charged for prostate checks for no reason. 

Following the nationwide probe, authorities in northern China’s Inner Mongolia Autonomous Region investigated a facility in Alshaa League involved in similar violations. After the facility was found to have breached insurance rules involving 16,128 yuan, it was fined five times the amount and stripped of its public insurance qualification. Evidence was also submitted to the local public security bureau for further penalties, with officials vowing to intensify efforts against such fraud.

China has expanded public health insurance coverage significantly over recent years, but that has opened up new opportunities for hospitals and patients to make money by making false claims.

According to domestic media, many cases involve patients exaggerating or fabricating illnesses in order to get prescriptions for valuable drugs, which they can then sell on the secondary market.

There have also been more serious scams in which gangs obtain false prescriptions on a larger scale, often colluding with doctors to gain access to patients’ insurance cards or to falsify medical records.

Chinese authorities have recently been stepping up efforts to clamp down on corruption in the health sector. In 2023, regulators reportedly inspected 802,000 medical institutions for insurance fraud, uncovering violations in 451,000 of them.

In March, the Supreme People’s Court, the Supreme People’s Procuratorate, and the Ministry of Public Security jointly published new guidelines that laid out extra penalties for those who conspire to commit insurance fraud.

“Insurance fraud poses a serious threat to the security of medical insurance funds and undermines the legitimate rights and interests of the public,” the document stated.

(Header image: VCG)