“Hysteroscopy Examination,” “Cervical Cancer Screening,” “Cervical Dilatation” are all gynecological diagnosis and treatment items, but some male patients surprisingly also incurred such medical insurance expenses. In some hospitals, there were even 1674 instances of such “bizarre” examinations conducted in a year. Various local medical insurance departments, following a unified deployment, are systematically investigating the big data issue clues issued by the National Medical Insurance Bureau.
What is the deal with men undergoing gynecological diagnosis and treatment?
Some belong to medical institutions swapping projects to defraud medical insurance. For example, the Leiyang City People’s Hospital in Hengyang, Hunan Province, replaced self-paid projects that are not covered by medical insurance with charged items like “High-Frequency Electric Knife Surgery” into reimbursable items such as “Intracavitary Color Doppler Ultrasound Examination (Transvaginal).” Similarly, the San San Yi Hospital in Zhuzhou, Hunan Province, transformed a self-paid project – “Painless Gastroscopy Anesthesia” (74 yuan/time) – into a Class B item “Hysteroscopy Anesthesia” (450 yuan/time) for reimbursement. These actions resulted in a large number of male patients incurring gynecological diagnosis and treatment costs. Why are they doing this? To defraud medical insurance!
Some incidents involve medical staff allowing female patients to use male insurance holders’ qualifications for medical treatment. For instance, medical staff at Wang Yanjun Clinic in Alxa League, Inner Mongolia Autonomous Region, allowed female patients to utilize male relatives’ medical security credentials for fee settlement after conducting “Transvaginal Color Doppler Ultrasound Examination.” Li Mou, a male employee at the Xingsha Branch of a livestock and poultry limited company in Hunan, had his female family members undergo gynecological diagnosis and treatment at the Yueyang Central Hospital in Hunan in September 2023, December 2023, and April 2024, with the related expenses all settled by swiping Li’s medical insurance card.
So, which medical institutions and doctors have the highest number of violations in such cases?
Table 1 shows the ranking of medical institutions where men undergo gynecological diagnosis and treatment.
Table 2 shows the ranking of doctors who issue gynecological diagnosis and treatment for men.
Next, under the guidance of the National Medical Insurance Bureau, medical insurance departments in various regions will continue to expand the screening scope, based on local conditions, to ensure full inspection and resolution of gender-related abnormal settlement issues in the region.
The net of the law is wide, but it does not let anything slip through. In the face of big data, can we still distinguish between genders?
Source: National Medical Insurance Bureau
