{"id":7344,"date":"2026-09-07T14:59:47","date_gmt":"2026-09-07T06:59:47","guid":{"rendered":"https:\/\/tmuhprc.tmu.edu.tw\/?p=7344"},"modified":"2026-09-07T15:04:04","modified_gmt":"2026-09-07T07:04:04","slug":"liberty-times-free-republic%e3%80%8bpo-chang-lee-911-cases-of-nhi-fraud-in-a-decade-reveal-a-major-governance-gap-in-taiwans-healthcare-system","status":"publish","type":"post","link":"https:\/\/tmuhprc.tmu.edu.tw\/en\/liberty-times-free-republic%e3%80%8bpo-chang-lee-911-cases-of-nhi-fraud-in-a-decade-reveal-a-major-governance-gap-in-taiwans-healthcare-system\/","title":{"rendered":"Liberty Times \u2013 Free Republic\u300bPo-Chang Lee: 911 Cases of NHI Fraud in a Decade Reveal a Major Governance Gap in Taiwan\u2019s Healthcare System"},"content":{"rendered":"

\"\"<\/p>\n

Po-Chang Lee \/ Chair Professor, College of Public Health, Taipei Medical University<\/h4>\n

How Did Impostors Get Admitted to Hospitals?<\/h3>\n

Investigations Should Not Stop with Those Who Collected the Insurance Payouts<\/strong><\/p>\n

On August 13, the Liberty Times<\/em> reported on its front page an insurance fraud case involving 17 members of three families. Since 2016, they had allegedly obtained hospital admissions by exaggerating illnesses, pretending to have suffered falls, or claiming to have acute gastroenteritis. They even allegedly hired \u201cimpostors\u201d to be hospitalized under other people\u2019s identities. Over a ten-year period, they filed 911 insurance claims with 13 insurance companies and fraudulently obtained more than NT$26.63 million in payouts. Remarkably, the decade-long scheme came to light only after Fubon Life Insurance detected irregularities and reported the case, prompting prosecutors and investigators to step in.<\/p>\n

Most readers may simply skim over a news story like this without giving it much thought. But if the reported use of impostors to assume other people\u2019s identities for hospitalization is ultimately confirmed by the courts, we should be asking further questions: How did these impostors pass the hospitals\u2019 identity verification procedures? Who did the physicians actually examine? Who were the nurses caring for? Whose information was entered into the medical records? And on what medical facts were the final diagnostic certificates issued?<\/p>\n

Raising these questions does not presume that the hospitals or physicians were accomplices. Healthcare institutions themselves may also have been deceived. Or were individual healthcare professionals knowingly involved? How many of these cases may have simultaneously exploited both National Health Insurance (NHI) and commercial insurance? Has the National Health Insurance Administration examined whether this was an isolated case or part of a systematic pattern of fraud? These are the questions that Taiwan must confront if it is serious about the governance of healthcare fraud.<\/p>\n

A NT$100,000 Threshold? Administrative Efficiency Must Not Become a Safe Harbor for Fraud<\/h3>\n

In 2023, the Ministry of Health and Welfare amended the Principles Governing Referral to Judicial Authorities of Criminal Cases Involving Article 81 of the National Health Insurance Act<\/em>. For certain suspected forms of fraudulent NHI claims, a claimed amount of NT$100,000 or more became an important threshold for referral to judicial authorities.<\/p>\n

At first glance, this may appear to be merely an administrative rule. In practice, however, it changes the gateway through which healthcare fraud cases enter the criminal justice system. For such a significant shift in financial governance, why was NT$100,000 considered an appropriate threshold? Before adopting the policy, was there any analysis of the distribution of monetary amounts involved in Taiwan\u2019s NHI fraud cases? Was the risk of small-scale but repeated fraud across multiple healthcare institutions assessed? Was there any study of the evasive behavior that such a threshold might encourage?<\/p>\n

If none of these questions were examined, then this is not simply administrative streamlining; it is governance without adequate financial risk assessment. Referral for criminal investigation is not merely a means of punishment\u2014it is also an investigative tool. Administrative audits and criminal investigations differ fundamentally in their ability to obtain evidence. When cases no longer enter the judicial process, networks of accomplices and related parties that might otherwise be uncovered through searches, seizures, financial-flow analysis, and investigations of associated individuals may remain hidden forever.<\/p>\n

Before changing the threshold for criminal referral, did policymakers fully understand that healthcare fraud is not simply a matter of the amount involved in any single claim, but rather a problem of incentives, patterns, networks, and the risk of organized crime? At the same time, the National Health Insurance Administration (NHIA) once maintained a dedicated \u201cViolation Investigation Task Force,\u201d but this specialized structure was discontinued following organizational and operational adjustments. When a higher threshold for criminal referral coincides with weakened specialized investigative capacity, what is affected is the organization\u2019s overall ability to identify and combat healthcare fraud.<\/p>\n

Frontline NHIA staff should not be blamed. They can only carry out their duties in accordance with the organizational framework and administrative rules under which they operate. Poor governance, however, can allow misconduct to hide behind the appearance of legitimate administrative procedures and remain embedded in the system for years.<\/p>\n

The Greatest Danger Is Not Failing to Recover a Few Thousand Dollars, but Allowing Fraud to Become a Calculable Cost<\/h3>\n

The deepest problem in the system lies in its incentives. Legitimate healthcare institutions will not suddenly engage in fraud simply because a NT$100,000 threshold exists, and the vast majority of physicians will continue to uphold professional ethics. But if deliberately false claims, once detected, result only in repayment and administrative fines\u2014and if smaller cases are unlikely to enter the criminal justice system\u2014then for the very small minority intent on exploiting loopholes, fraud may be recalculated from a \u201ccriminal risk\u201d into a \u201ccost of doing business.\u201d That is where the real danger lies.<\/p>\n

When the expected gains from misconduct exceed the probability of detection multiplied by the cost of punishment, the system itself creates opportunities for exploitation. This is not fundamentally a question of medical ethics; it is a basic problem of incentive design. I have long opposed the excessive use of claim deductions as a means of regulating the medical profession, because determining medical necessity requires professional judgment, and physicians who practice legitimately should not be treated as potential offenders. But opposing unreasonable claim deductions does not mean opposing the investigation of genuine healthcare fraud. In fact, the best way to protect law-abiding physicians is to identify actual fraudsters with greater precision.<\/p>\n

Human behavior must be taken into account in any system of financial governance. Publicly listed companies have financial audit mechanisms. In the United States, much healthcare reimbursement is administered through private insurers, which employ large numbers of professionals to conduct medical reviews and financial oversight. In Taiwan, reimbursement by private insurers often requires documentation such as diagnostic certificates issued by healthcare institutions.<\/p>\n

Commercial health insurance and National Health Insurance should therefore not operate as two completely separate worlds of financial governance. Within the healthcare sector, there is often a misconception that larger global budgets will necessarily lead to better quality of care, while insufficient attention is paid to the fundamental question of where the money comes from. Generally speaking, NHIA personnel are not trained in financial oversight with the same degree of precision as professional government auditors, nor can they realistically be expected to manage the NHI global budget as though it were their own household money.<\/p>\n

If fraudulent hospitalizations do exist, the same false hospitalization could be used both to obtain payouts from private insurers through medical certificates and to have medical expenses reimbursed by National Health Insurance. The victims, therefore, would not be limited to the 13 insurance companies involved. The losses would also be borne by the NHI global budget funded collectively by more than 23 million people in Taiwan\u2014and would ultimately reduce the resources available to law-abiding physicians.<\/p>\n

Technology today has advanced to the point where the methods of governance can be fundamentally transformed. The NHIA possesses an enormous volume of claims data and should establish a comprehensive risk-assessment system capable of identifying unusually long hospital stays, abnormal combinations of medical devices or supplies, repeated diagnostic patterns, groups of patients appearing across multiple healthcare institutions, unusual growth rates associated with particular physicians or institutions, and claims patterns that cannot be reasonably explained by peer comparisons.<\/p>\n

What the NHIA Needs Is Not More Claim Deductions, but Professional Anti-Fraud Capacity<\/h3>\n

What truly matters is whether the finances of National Health Insurance are being managed effectively and pragmatically. We do not want NHI resources wasted on unnecessary medical services, and even more importantly, we do not want the NHI global budget to be depleted through fraud.<\/p>\n

I have always believed that the NHIA\u2019s role should not be adversarial toward the medical profession. Good governance means allowing physicians who genuinely devote themselves to patient care to practice without fear of unreasonable claim deductions, while ensuring that the small minority who deliberately exploit the healthcare system for financial gain understand that abnormal behavior will be detected and that deliberate fraud will carry consequences proportionate to the offense.<\/p>\n

The government should therefore review the principles governing criminal referrals under Article 81 of the National Health Insurance Act; restore or rebuild a dedicated anti-fraud team with expertise in medicine, law, data science, and investigation; establish an institutionalized mechanism for information sharing between National Health Insurance and commercial insurers in major suspected fraud cases; and upgrade fraud detection from \u201cmanual review of individual claims\u201d to a system based on \u201cdata-driven analysis, pattern recognition, risk stratification, and network investigation.\u201d<\/p>\n

\u201cThe greatest danger to NHI reform is not that someone may exploit a loophole\u2014it is that the system fails to recognize the loopholes it has created.\u201d<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Po-Chang Lee \/ Chair Professor, College of Public Health, Taipei Medical University How Did Impostors Get Admitted to Hospitals? Investigations Should Not Stop with Those Who Collected the Insurance Payouts On August 13, the Liberty Times reported on its front page an insurance fraud case involving 17 members of three families. Since 2016, they had […]<\/p>\n","protected":false},"author":14,"featured_media":7339,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[91],"tags":[],"yoast_head":"\nLiberty Times \u2013 Free Republic\u300bPo-Chang Lee: 911 Cases of NHI Fraud in a Decade Reveal a Major Governance Gap in Taiwan\u2019s Healthcare System - \u81fa\u5317\u91ab\u5b78\u5927\u5b78\u885b\u751f\u798f\u5229\u653f\u7b56\u7814\u7a76\u4e2d\u5fc3<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/tmuhprc.tmu.edu.tw\/en\/liberty-times-free-republic\u300bpo-chang-lee-911-cases-of-nhi-fraud-in-a-decade-reveal-a-major-governance-gap-in-taiwans-healthcare-system\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Liberty Times \u2013 Free Republic\u300bPo-Chang Lee: 911 Cases of NHI Fraud in a Decade Reveal a Major Governance Gap in Taiwan\u2019s Healthcare System - \u81fa\u5317\u91ab\u5b78\u5927\u5b78\u885b\u751f\u798f\u5229\u653f\u7b56\u7814\u7a76\u4e2d\u5fc3\" \/>\n<meta property=\"og:description\" content=\"Po-Chang Lee \/ Chair Professor, College of Public Health, Taipei Medical University How Did Impostors Get Admitted to Hospitals? 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Investigations Should Not Stop with Those Who Collected the Insurance Payouts On August 13, the Liberty Times reported on its front page an insurance fraud case involving 17 members of three families. 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