Overview of the Fraud Scheme
A 58-year-old man, identified as Sukho, was arrested by police on suspicion of healthcare fraud, causing damages of over 1.2 million baht to the National Health Security Office (NHSO). The suspect was apprehended at a hospital in Ratchathewi district of Bangkok after Crime Suppression Division (CSD) investigators received a tip-off about his upcoming visit.
The NHSO’s Universal Health Coverage Scheme
The NHSO operates the universal health coverage scheme in Thailand, providing healthcare services to its citizens. Sukho was accused of exploiting this scheme for several years, seeking services that were not medically necessary.
Detection and Investigation of the Fraud
The fraud was initially detected in February 2020 when the NHSO reviewed the records of a patient who sought emergency treatment for chronic obstructive pulmonary disease (COPD) every few days at different state-run hospitals. The investigation revealed that from 2010 to 2016, the same patient made 675 requests for emergency treatment for COPD and other illnesses at various hospitals in different provinces.
Medications and Abnormal Frequency of Visits
During most visits, the patient was prescribed oral and inhaled medications to alleviate symptoms. According to the NHSO, inhaled medication for COPD can be used 200 times per bottle or for 60 days, making the patient’s frequent visits irregular. Taking into account the market prices of inhaled medications, between 350 and 400 baht per bottle, the NHSO suspected the individual was committing fraud and reselling the medication.
Financial Impact of the Fraud
The estimated financial damage caused by the fraudulent activities from 2010 to 2016 is over 1.2 million baht. The arrest of Sukho is an essential step towards curbing such fraudulent practices and safeguarding the healthcare system in Thailand.