英文摘要 |
The results of this study shows that there is no objective standard for probation judgments, judgments and fines are also without objective criteria, although the sentenced days has positive correlation with the sum of fraud, but still the high variability existed for sentencing, depending on the freedom of individual judges, leading to no objective standard for sentencing. Total cases for health care fraud between 2008 and 2011 from district courts are only 97 with total number of 184 defendants, this number is too low because the accused defendants accepting legal sanctions only are the tip of the iceberg of the number of all criminals. It needs enhancement and encouragement for people and NHI to report the criminal information to our judicial units, in order to deter the doctors from committing the crime of health care. The study found that present criminal law has no effect on deterrence from committing health care fraud, because the average sentence for health care fraud is about 8-9 months, and probation rate is higher than other fraud case. Therefore, this study shows that the current problems for health care fraud sentencing are legal aspects for judgment: (1) the degree of punishment is too low (2) capital felony but lenient sentence (3) no standard sentencing guideline. Therefore, to prevent the occurrence of health care fraud, amending the law in the future is necessary. The authors propose the following suggestions: First, add special articles or special section for health care fraud in the criminal law. Second, increase sentencing penalties and fines. Third, set up specialized tribunal to investigate and put to trial for health care fraud, and to improve the quality of the adjudgement. Fourth, we should learn to set up team model to fight against health care fraud from U.S. experience. For example, to establish integrated prevention units for health care fraud from various branches of National Health Insurance Bureau, the prosecutors office of Ministry of Justic, the Department of Health and local health authorities. Fifth, to review the regulations and articles of NHI related to inspection and punishment for the medical fraud immediately. Strict inspection and punishment for committing health care fraud is necessary, especially for physicians and medical institutions with poor management. Implement permanent health insurance contract termination for administrative sanctions is necessary to prevent the occurrence of health care fraud. Finally, enhancing the administrative penalties against physicians committing health care fraud crime from health authorities and the Department of Health, such as warnings, limit the scope of practice, suspension, revocation of license to practice is also regarded as an effective modality to prevent health care fraud. |