Improve UCS fund management with effective audit system
Improve UCS fund management with effective audit system
Exclusive interview with Karoon Khuntiranont, Deputy Secretary-General of National Health Security Office (NHSO)
The implementation of Universal Health Scheme (UCS) needs more than a benefit design. It requires an effective fund management and audit system that can reflects the efficient, good governance of fund management system, and ensure transparent spending of the UCS fund.
Since the scheme's introduction in 2002, the National Health Security Office (NHSO), a Thai government agency running the UCS, has developed a fund monitoring tool and system to ensure that any expenditures are traceable and worthiness.
Dr Karoon Khuntiranont, the NHSO Deputy Secretary-General, explains how the monitoring system works.
How does the NHSO monitor the UCS fund spending and ensure the transparency in the fund management?
Dr Karoon : The Audit system was implemented to be able to audit both Accounting audit according to financing criteria and Medical care audit according to clinical professional guideline (CPG). We’ve implemented five types of audits. First, coding audit, its purpose was to verify correctness of principle diagnosis, other diagnosis, procedure against clinical evidence of Diagnosis Related Group or DRG as recommend by Clinical Practice Guideline or CPG. Second, billing audits to verify actual costs against reimbursement for additional payment outside of DRG. We trace the transactions and expenditures of health providers who request reimbursement additional form DRG, we’ll examine each item in their bills.
Thrid, quality audits. We look at the quality of services provided by health providers to see whether they comply with CPG, which is written and agreed by medical professional associations.
Fourth, medical record audits. We examine the accuracy of medical records. Finally, collaborative audits. the NHSO has collaborated and integrate the audit system by use the same standard to audit other two healthcare schemes — Social Security Scheme and Civil Servants Medical Benefits Scheme.
What are the purposes of these audits?
Dr Karoon: First, our audits aim to increase the efficiency and reflect good governance of the UCS fund management and reduce the money leaks. Second, performing audits ensures the accuracy of medical fees and services reimbursement and transparent spending of the UCS fund. Third, regular audits will improve correctness our reimbursement system that has involved health units and hospitals at all levels. Forth, the information collected during the audits procedure can be used for improving a national database of patients. Finally, audits will help us standardize the reimbursement system for every Thai healthcare scheme.
The NHSO has many bureaus focusing on different tasks, and you direct the Bureau of Claims and Medical Audits. Can you tell us what the role of the bureau is?
Dr Karoon : Our primary roles are directing the organization's audit policy and develop the audit guidelines. We have many different tasks.
First, we've recruited auditors who are doctors and nurses working in public and private hospitals. They must go through training in examining medical records and act in compliance with the code of conduct, which they must avoid conflict of interest with health units under audits. We've also evaluated their performance and retrained them every year.
Second, we've launched random inspections on health providers every year. We selected health providers based on their past performance, called hospital grading. The health providers that often make errors in their claim documents will have a higher chance to face inspection than the ones with good records. We also set over 80 criteria for the selections, and collaborate with other healthcare schemes'' operators on performing audits.
Third, we've issued reports of inspection results for health providers and individual healthcare operators. If they disagree with the results, they can appeal against us three rounds. If we can't settle the case, we'll invite external professionals to help us decide on the third round of appealing.
What kinds of errors do you often find during the inspections?
Dr Karoon : We've found both unintentional and intentional errors. For inadvertent errors, health providers may be negligent or unaware that they've filled up false information in their claim documents. We've found this kind of mistakes every year, and worked with health providers to correct the information. If they under claim, they claim money less than they should do, we reimburse the fund to them. If they over claim the fund, we ask them to return the exceeding fund to us.
We've found very few cases of health providing making errors on intention. When we find errors, health providers can defend themselves by providing support documents. The recent case we found is the last-year fraudulent claims of 18 clinics in Bangkok. The clinic operators use the false name of UCS beneficiaries for nonexistent patients who supposedly received medical examinations and used them to claim reimbursements from the NHSO, although the beneficiaries didn't receive any services.
You mentioned about the fraudulent claims of 18 clinics. Can you tell us more about that, and how does it reflect the capacity of the NHSO audit?
Dr Karoon : Last year, our audit team found some irregularities in the claim documents of 45 clinics in Bangkok. Their claims for health promotion and disease prevention services, including screening tests for hypertension and diabetes, were in an irrational high amount. So we investigated their bills and found that 18 out of 45 clinics changed eh health records of some patients, adding false information so they could claim additional reimbursement, For example, the record of patient with a normal body mass index might be changed to greater health risk so the clinic could reimbursement more money. Our finding reflects the effectiveness of our audit system, which can detect irregularities before we would face severe loss.
Does the NHSO have a plan to improve the audit system, and how?
Dr Karoon : We have learned quite a lot from the case of 18 clinics' fraudulent claims. Most of their fraudulent claims were in items relating to health promotion and disease prevention services. Health providers all over Thailand provide these services around 25-30 million times a year. It's impossible for us to inspect every item in their bills.
Therefore, we're planning to integrate technology into our claim system so we can increase our capacity in monitoring and inspecting the claim documents. One of the technologies we've interested in is "the beneficiary identification system," which implements a condition that the UCS beneficiaries must register online before their hospital visits. They'll get the QR codes and show it to health providers, who can only claim the UCS fund when having these QR codes. We've tried this system since 1 Aug.
The other technology we are looking at is "the smart card scanning." The UCS beneficiaries must scan their ID cards at health units, of which operators will get the codes used for claiming the UCS fund. We'll pilot the smart card scanning next month at Chulabhorn Research Institute. By next year, we plan to expand it to all Bangkok clinics signed contracts with the NHSO. For the beneficiaries lagging digital literacy, health providers may need to request their signatures during their visits. But after they can adapt to the changes, they must register through the beneficiary identification system.
Moreover, we've been developing other solutions by collaborating with an outsourcing tech company. One of the solutions is to analyze the create a software that can detect a tendency of fraudulent claims — by looking at the clinics' service capacity. If a clinic has a capacity of performing 50 screening tests a day, but they do 200, or a clinic may provide heart disease diagnosis despite having no cardiologist, it may have a tendency of fraud. We can also look at the UCS population and medial record history of a clinic to find the tendency.
In the case of high-cost medical services, such as stem cell transplants and immunoglobulin therapy, we're thinking about putting the system that health providers must request pre-authorization before giving out services. In the future, we may also reimburse the UCS fund base on the outcomes instead of outputs. For example, we've currently reimbursed the fund for cervical screening to health providers by counting the number of providing tests. We may instead reimburse the fund by measuring the prevalence of cervical cancer in the area and how it reduces after the tests are provided.
IN DEPTH
Improve UCS fund management with effective audit system
Improve UCS fund management with effective audit system
Exclusive interview with Karoon Khuntiranont, Deputy Secretary-General of National Health Security Office (NHSO)
The implementation of Universal Health Scheme (UCS) needs more than a benefit design. It requires an effective fund management and audit system that can reflects the efficient, good governance of fund management system, and ensure transparent spending of the UCS fund.
Since the scheme's introduction in 2002, the National Health Security Office (NHSO), a Thai government agency running the UCS, has developed a fund monitoring tool and system to ensure that any expenditures are traceable and worthiness.
Dr Karoon Khuntiranont, the NHSO Deputy Secretary-General, explains how the monitoring system works.
How does the NHSO monitor the UCS fund spending and ensure the transparency in the fund management?
Dr Karoon : The Audit system was implemented to be able to audit both Accounting audit according to financing criteria and Medical care audit according to clinical professional guideline (CPG). We’ve implemented five types of audits. First, coding audit, its purpose was to verify correctness of principle diagnosis, other diagnosis, procedure against clinical evidence of Diagnosis Related Group or DRG as recommend by Clinical Practice Guideline or CPG. Second, billing audits to verify actual costs against reimbursement for additional payment outside of DRG. We trace the transactions and expenditures of health providers who request reimbursement additional form DRG, we’ll examine each item in their bills.
Thrid, quality audits. We look at the quality of services provided by health providers to see whether they comply with CPG, which is written and agreed by medical professional associations.
Fourth, medical record audits. We examine the accuracy of medical records. Finally, collaborative audits. the NHSO has collaborated and integrate the audit system by use the same standard to audit other two healthcare schemes — Social Security Scheme and Civil Servants Medical Benefits Scheme.
What are the purposes of these audits?
Dr Karoon: First, our audits aim to increase the efficiency and reflect good governance of the UCS fund management and reduce the money leaks. Second, performing audits ensures the accuracy of medical fees and services reimbursement and transparent spending of the UCS fund. Third, regular audits will improve correctness our reimbursement system that has involved health units and hospitals at all levels. Forth, the information collected during the audits procedure can be used for improving a national database of patients. Finally, audits will help us standardize the reimbursement system for every Thai healthcare scheme.
The NHSO has many bureaus focusing on different tasks, and you direct the Bureau of Claims and Medical Audits. Can you tell us what the role of the bureau is?
Dr Karoon : Our primary roles are directing the organization's audit policy and develop the audit guidelines. We have many different tasks.
First, we've recruited auditors who are doctors and nurses working in public and private hospitals. They must go through training in examining medical records and act in compliance with the code of conduct, which they must avoid conflict of interest with health units under audits. We've also evaluated their performance and retrained them every year.
Second, we've launched random inspections on health providers every year. We selected health providers based on their past performance, called hospital grading. The health providers that often make errors in their claim documents will have a higher chance to face inspection than the ones with good records. We also set over 80 criteria for the selections, and collaborate with other healthcare schemes'' operators on performing audits.
Third, we've issued reports of inspection results for health providers and individual healthcare operators. If they disagree with the results, they can appeal against us three rounds. If we can't settle the case, we'll invite external professionals to help us decide on the third round of appealing.
What kinds of errors do you often find during the inspections?
Dr Karoon : We've found both unintentional and intentional errors. For inadvertent errors, health providers may be negligent or unaware that they've filled up false information in their claim documents. We've found this kind of mistakes every year, and worked with health providers to correct the information. If they under claim, they claim money less than they should do, we reimburse the fund to them. If they over claim the fund, we ask them to return the exceeding fund to us.
We've found very few cases of health providing making errors on intention. When we find errors, health providers can defend themselves by providing support documents. The recent case we found is the last-year fraudulent claims of 18 clinics in Bangkok. The clinic operators use the false name of UCS beneficiaries for nonexistent patients who supposedly received medical examinations and used them to claim reimbursements from the NHSO, although the beneficiaries didn't receive any services.
You mentioned about the fraudulent claims of 18 clinics. Can you tell us more about that, and how does it reflect the capacity of the NHSO audit?
Dr Karoon : Last year, our audit team found some irregularities in the claim documents of 45 clinics in Bangkok. Their claims for health promotion and disease prevention services, including screening tests for hypertension and diabetes, were in an irrational high amount. So we investigated their bills and found that 18 out of 45 clinics changed eh health records of some patients, adding false information so they could claim additional reimbursement, For example, the record of patient with a normal body mass index might be changed to greater health risk so the clinic could reimbursement more money. Our finding reflects the effectiveness of our audit system, which can detect irregularities before we would face severe loss.
Does the NHSO have a plan to improve the audit system, and how?
Dr Karoon : We have learned quite a lot from the case of 18 clinics' fraudulent claims. Most of their fraudulent claims were in items relating to health promotion and disease prevention services. Health providers all over Thailand provide these services around 25-30 million times a year. It's impossible for us to inspect every item in their bills.
Therefore, we're planning to integrate technology into our claim system so we can increase our capacity in monitoring and inspecting the claim documents. One of the technologies we've interested in is "the beneficiary identification system," which implements a condition that the UCS beneficiaries must register online before their hospital visits. They'll get the QR codes and show it to health providers, who can only claim the UCS fund when having these QR codes. We've tried this system since 1 Aug.
The other technology we are looking at is "the smart card scanning." The UCS beneficiaries must scan their ID cards at health units, of which operators will get the codes used for claiming the UCS fund. We'll pilot the smart card scanning next month at Chulabhorn Research Institute. By next year, we plan to expand it to all Bangkok clinics signed contracts with the NHSO. For the beneficiaries lagging digital literacy, health providers may need to request their signatures during their visits. But after they can adapt to the changes, they must register through the beneficiary identification system.
Moreover, we've been developing other solutions by collaborating with an outsourcing tech company. One of the solutions is to analyze the create a software that can detect a tendency of fraudulent claims — by looking at the clinics' service capacity. If a clinic has a capacity of performing 50 screening tests a day, but they do 200, or a clinic may provide heart disease diagnosis despite having no cardiologist, it may have a tendency of fraud. We can also look at the UCS population and medial record history of a clinic to find the tendency.
In the case of high-cost medical services, such as stem cell transplants and immunoglobulin therapy, we're thinking about putting the system that health providers must request pre-authorization before giving out services. In the future, we may also reimburse the UCS fund base on the outcomes instead of outputs. For example, we've currently reimbursed the fund for cervical screening to health providers by counting the number of providing tests. We may instead reimburse the fund by measuring the prevalence of cervical cancer in the area and how it reduces after the tests are provided.
Events
Improve UCS fund management with effective audit system
Improve UCS fund management with effective audit system
Exclusive interview with Karoon Khuntiranont, Deputy Secretary-General of National Health Security Office (NHSO)
The implementation of Universal Health Scheme (UCS) needs more than a benefit design. It requires an effective fund management and audit system that can reflects the efficient, good governance of fund management system, and ensure transparent spending of the UCS fund.
Since the scheme's introduction in 2002, the National Health Security Office (NHSO), a Thai government agency running the UCS, has developed a fund monitoring tool and system to ensure that any expenditures are traceable and worthiness.
Dr Karoon Khuntiranont, the NHSO Deputy Secretary-General, explains how the monitoring system works.
How does the NHSO monitor the UCS fund spending and ensure the transparency in the fund management?
Dr Karoon : The Audit system was implemented to be able to audit both Accounting audit according to financing criteria and Medical care audit according to clinical professional guideline (CPG). We’ve implemented five types of audits. First, coding audit, its purpose was to verify correctness of principle diagnosis, other diagnosis, procedure against clinical evidence of Diagnosis Related Group or DRG as recommend by Clinical Practice Guideline or CPG. Second, billing audits to verify actual costs against reimbursement for additional payment outside of DRG. We trace the transactions and expenditures of health providers who request reimbursement additional form DRG, we’ll examine each item in their bills.
Thrid, quality audits. We look at the quality of services provided by health providers to see whether they comply with CPG, which is written and agreed by medical professional associations.
Fourth, medical record audits. We examine the accuracy of medical records. Finally, collaborative audits. the NHSO has collaborated and integrate the audit system by use the same standard to audit other two healthcare schemes — Social Security Scheme and Civil Servants Medical Benefits Scheme.
What are the purposes of these audits?
Dr Karoon: First, our audits aim to increase the efficiency and reflect good governance of the UCS fund management and reduce the money leaks. Second, performing audits ensures the accuracy of medical fees and services reimbursement and transparent spending of the UCS fund. Third, regular audits will improve correctness our reimbursement system that has involved health units and hospitals at all levels. Forth, the information collected during the audits procedure can be used for improving a national database of patients. Finally, audits will help us standardize the reimbursement system for every Thai healthcare scheme.
The NHSO has many bureaus focusing on different tasks, and you direct the Bureau of Claims and Medical Audits. Can you tell us what the role of the bureau is?
Dr Karoon : Our primary roles are directing the organization's audit policy and develop the audit guidelines. We have many different tasks.
First, we've recruited auditors who are doctors and nurses working in public and private hospitals. They must go through training in examining medical records and act in compliance with the code of conduct, which they must avoid conflict of interest with health units under audits. We've also evaluated their performance and retrained them every year.
Second, we've launched random inspections on health providers every year. We selected health providers based on their past performance, called hospital grading. The health providers that often make errors in their claim documents will have a higher chance to face inspection than the ones with good records. We also set over 80 criteria for the selections, and collaborate with other healthcare schemes'' operators on performing audits.
Third, we've issued reports of inspection results for health providers and individual healthcare operators. If they disagree with the results, they can appeal against us three rounds. If we can't settle the case, we'll invite external professionals to help us decide on the third round of appealing.
What kinds of errors do you often find during the inspections?
Dr Karoon : We've found both unintentional and intentional errors. For inadvertent errors, health providers may be negligent or unaware that they've filled up false information in their claim documents. We've found this kind of mistakes every year, and worked with health providers to correct the information. If they under claim, they claim money less than they should do, we reimburse the fund to them. If they over claim the fund, we ask them to return the exceeding fund to us.
We've found very few cases of health providing making errors on intention. When we find errors, health providers can defend themselves by providing support documents. The recent case we found is the last-year fraudulent claims of 18 clinics in Bangkok. The clinic operators use the false name of UCS beneficiaries for nonexistent patients who supposedly received medical examinations and used them to claim reimbursements from the NHSO, although the beneficiaries didn't receive any services.
You mentioned about the fraudulent claims of 18 clinics. Can you tell us more about that, and how does it reflect the capacity of the NHSO audit?
Dr Karoon : Last year, our audit team found some irregularities in the claim documents of 45 clinics in Bangkok. Their claims for health promotion and disease prevention services, including screening tests for hypertension and diabetes, were in an irrational high amount. So we investigated their bills and found that 18 out of 45 clinics changed eh health records of some patients, adding false information so they could claim additional reimbursement, For example, the record of patient with a normal body mass index might be changed to greater health risk so the clinic could reimbursement more money. Our finding reflects the effectiveness of our audit system, which can detect irregularities before we would face severe loss.
Does the NHSO have a plan to improve the audit system, and how?
Dr Karoon : We have learned quite a lot from the case of 18 clinics' fraudulent claims. Most of their fraudulent claims were in items relating to health promotion and disease prevention services. Health providers all over Thailand provide these services around 25-30 million times a year. It's impossible for us to inspect every item in their bills.
Therefore, we're planning to integrate technology into our claim system so we can increase our capacity in monitoring and inspecting the claim documents. One of the technologies we've interested in is "the beneficiary identification system," which implements a condition that the UCS beneficiaries must register online before their hospital visits. They'll get the QR codes and show it to health providers, who can only claim the UCS fund when having these QR codes. We've tried this system since 1 Aug.
The other technology we are looking at is "the smart card scanning." The UCS beneficiaries must scan their ID cards at health units, of which operators will get the codes used for claiming the UCS fund. We'll pilot the smart card scanning next month at Chulabhorn Research Institute. By next year, we plan to expand it to all Bangkok clinics signed contracts with the NHSO. For the beneficiaries lagging digital literacy, health providers may need to request their signatures during their visits. But after they can adapt to the changes, they must register through the beneficiary identification system.
Moreover, we've been developing other solutions by collaborating with an outsourcing tech company. One of the solutions is to analyze the create a software that can detect a tendency of fraudulent claims — by looking at the clinics' service capacity. If a clinic has a capacity of performing 50 screening tests a day, but they do 200, or a clinic may provide heart disease diagnosis despite having no cardiologist, it may have a tendency of fraud. We can also look at the UCS population and medial record history of a clinic to find the tendency.
In the case of high-cost medical services, such as stem cell transplants and immunoglobulin therapy, we're thinking about putting the system that health providers must request pre-authorization before giving out services. In the future, we may also reimburse the UCS fund base on the outcomes instead of outputs. For example, we've currently reimbursed the fund for cervical screening to health providers by counting the number of providing tests. We may instead reimburse the fund by measuring the prevalence of cervical cancer in the area and how it reduces after the tests are provided.
RESOURCE CENTER
SECRETARY-GENERAL
Improve UCS fund management with effective audit system
Improve UCS fund management with effective audit system
Exclusive interview with Karoon Khuntiranont, Deputy Secretary-General of National Health Security Office (NHSO)
The implementation of Universal Health Scheme (UCS) needs more than a benefit design. It requires an effective fund management and audit system that can reflects the efficient, good governance of fund management system, and ensure transparent spending of the UCS fund.
Since the scheme's introduction in 2002, the National Health Security Office (NHSO), a Thai government agency running the UCS, has developed a fund monitoring tool and system to ensure that any expenditures are traceable and worthiness.
Dr Karoon Khuntiranont, the NHSO Deputy Secretary-General, explains how the monitoring system works.
How does the NHSO monitor the UCS fund spending and ensure the transparency in the fund management?
Dr Karoon : The Audit system was implemented to be able to audit both Accounting audit according to financing criteria and Medical care audit according to clinical professional guideline (CPG). We’ve implemented five types of audits. First, coding audit, its purpose was to verify correctness of principle diagnosis, other diagnosis, procedure against clinical evidence of Diagnosis Related Group or DRG as recommend by Clinical Practice Guideline or CPG. Second, billing audits to verify actual costs against reimbursement for additional payment outside of DRG. We trace the transactions and expenditures of health providers who request reimbursement additional form DRG, we’ll examine each item in their bills.
Thrid, quality audits. We look at the quality of services provided by health providers to see whether they comply with CPG, which is written and agreed by medical professional associations.
Fourth, medical record audits. We examine the accuracy of medical records. Finally, collaborative audits. the NHSO has collaborated and integrate the audit system by use the same standard to audit other two healthcare schemes — Social Security Scheme and Civil Servants Medical Benefits Scheme.
What are the purposes of these audits?
Dr Karoon: First, our audits aim to increase the efficiency and reflect good governance of the UCS fund management and reduce the money leaks. Second, performing audits ensures the accuracy of medical fees and services reimbursement and transparent spending of the UCS fund. Third, regular audits will improve correctness our reimbursement system that has involved health units and hospitals at all levels. Forth, the information collected during the audits procedure can be used for improving a national database of patients. Finally, audits will help us standardize the reimbursement system for every Thai healthcare scheme.
The NHSO has many bureaus focusing on different tasks, and you direct the Bureau of Claims and Medical Audits. Can you tell us what the role of the bureau is?
Dr Karoon : Our primary roles are directing the organization's audit policy and develop the audit guidelines. We have many different tasks.
First, we've recruited auditors who are doctors and nurses working in public and private hospitals. They must go through training in examining medical records and act in compliance with the code of conduct, which they must avoid conflict of interest with health units under audits. We've also evaluated their performance and retrained them every year.
Second, we've launched random inspections on health providers every year. We selected health providers based on their past performance, called hospital grading. The health providers that often make errors in their claim documents will have a higher chance to face inspection than the ones with good records. We also set over 80 criteria for the selections, and collaborate with other healthcare schemes'' operators on performing audits.
Third, we've issued reports of inspection results for health providers and individual healthcare operators. If they disagree with the results, they can appeal against us three rounds. If we can't settle the case, we'll invite external professionals to help us decide on the third round of appealing.
What kinds of errors do you often find during the inspections?
Dr Karoon : We've found both unintentional and intentional errors. For inadvertent errors, health providers may be negligent or unaware that they've filled up false information in their claim documents. We've found this kind of mistakes every year, and worked with health providers to correct the information. If they under claim, they claim money less than they should do, we reimburse the fund to them. If they over claim the fund, we ask them to return the exceeding fund to us.
We've found very few cases of health providing making errors on intention. When we find errors, health providers can defend themselves by providing support documents. The recent case we found is the last-year fraudulent claims of 18 clinics in Bangkok. The clinic operators use the false name of UCS beneficiaries for nonexistent patients who supposedly received medical examinations and used them to claim reimbursements from the NHSO, although the beneficiaries didn't receive any services.
You mentioned about the fraudulent claims of 18 clinics. Can you tell us more about that, and how does it reflect the capacity of the NHSO audit?
Dr Karoon : Last year, our audit team found some irregularities in the claim documents of 45 clinics in Bangkok. Their claims for health promotion and disease prevention services, including screening tests for hypertension and diabetes, were in an irrational high amount. So we investigated their bills and found that 18 out of 45 clinics changed eh health records of some patients, adding false information so they could claim additional reimbursement, For example, the record of patient with a normal body mass index might be changed to greater health risk so the clinic could reimbursement more money. Our finding reflects the effectiveness of our audit system, which can detect irregularities before we would face severe loss.
Does the NHSO have a plan to improve the audit system, and how?
Dr Karoon : We have learned quite a lot from the case of 18 clinics' fraudulent claims. Most of their fraudulent claims were in items relating to health promotion and disease prevention services. Health providers all over Thailand provide these services around 25-30 million times a year. It's impossible for us to inspect every item in their bills.
Therefore, we're planning to integrate technology into our claim system so we can increase our capacity in monitoring and inspecting the claim documents. One of the technologies we've interested in is "the beneficiary identification system," which implements a condition that the UCS beneficiaries must register online before their hospital visits. They'll get the QR codes and show it to health providers, who can only claim the UCS fund when having these QR codes. We've tried this system since 1 Aug.
The other technology we are looking at is "the smart card scanning." The UCS beneficiaries must scan their ID cards at health units, of which operators will get the codes used for claiming the UCS fund. We'll pilot the smart card scanning next month at Chulabhorn Research Institute. By next year, we plan to expand it to all Bangkok clinics signed contracts with the NHSO. For the beneficiaries lagging digital literacy, health providers may need to request their signatures during their visits. But after they can adapt to the changes, they must register through the beneficiary identification system.
Moreover, we've been developing other solutions by collaborating with an outsourcing tech company. One of the solutions is to analyze the create a software that can detect a tendency of fraudulent claims — by looking at the clinics' service capacity. If a clinic has a capacity of performing 50 screening tests a day, but they do 200, or a clinic may provide heart disease diagnosis despite having no cardiologist, it may have a tendency of fraud. We can also look at the UCS population and medial record history of a clinic to find the tendency.
In the case of high-cost medical services, such as stem cell transplants and immunoglobulin therapy, we're thinking about putting the system that health providers must request pre-authorization before giving out services. In the future, we may also reimburse the UCS fund base on the outcomes instead of outputs. For example, we've currently reimbursed the fund for cervical screening to health providers by counting the number of providing tests. We may instead reimburse the fund by measuring the prevalence of cervical cancer in the area and how it reduces after the tests are provided.
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