Prosecutors charge 109 people in medical insurance case

Taipei prosecutors yesterday charged 109 people with medical insurance fraud in a case allegedly involving medical group Dianthus, as well as insurance sales agents and people who filed insurance claims.

Suspects charged with fraud and forging documents include Dianthus Medical Group chief executive Lin Tzu-hung (林思宏), four doctors, other company medical staff and 19 insurance agents, it said. Taipei District Attorney’s Office.

Eighty people who filed insurance claims naming Dianthus were also among those charged, prosecutors said.

Photo: Tsai Ssu-pei, Taipei Times

The company operates 10 clinics in Taipei and two in Taoyuan specializing in maternal-fetal medicine, gynecology and other fields, its website says.

Prosecutors said they launched an investigation into the company’s operations after Hontai Life Insurance earlier this year reported discrepancies in numerous claims filed by people who named Dianthus.

The claims, which were specific to five Dianthus clinics, were based on allegedly false medical information, in an effort to obtain reimbursements, prosecutors said.

For example, people allegedly submitted insurance claims for unavoidable C-section deliveries when they opted for the procedure, prosecutors said.

Insurance claims incorrectly cite birth complications such as “fetal malpresentation” that required such surgery, prosecutors said.

Insurance agents allegedly colluded with Dianthus in offers for clients, prosecutors said.

Investigators found that 10 insurance companies were involved and the proceeds from the alleged fraud and counterfeiting amounted to approximately NT$67 million (US$2.24 million), prosecutors said.

The prosecutors’ office said it was seeking significant penalties for Lin and the four staff doctors, given the potential damage to doctors’ reputations and the nationwide medical insurance system.

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