Accordingly, in order to limit fraud and profiteering of social insurance, unemployment insurance and health insurance funds, over the past time, Vietnam Social Security (VSS) has promulgated various documents directing and instructing social security offices in provinces and cities to proactively and drastically take solutions to prevent, detect and stop violations of law on social insurance, unemployment insurance and health insurance. The Vietnam social security industry has timely detected and addressed numerous offences and resolved many shortcomings or reported to the competent authorities for proper settlement. Recently, VSS and certain relevant bodies have found and dealt with violations in some localities as follows:

Abusing, profiteering sickness and maternity benefits

Labourers take advantage of the social insurance fund through using fake certificate of work leave to enjoy social insurance benefits. Medical establishments also profiteer from the health insurance fund by settling medical examination, medicine and technical services costs from the health insurance cards of the buyers of such fake certificates. Some typical cases have been found at a private medical facility in Dong Nai Province (the case has been prosecuted); at the medical centre in Dong Van Ward, Duy Tien Town in Ha Nam Province (the case is being verified by the provincial police), among others.

In addition, in order to abuse the social insurance fund, employers suggest to settle sickness, maternity and health recovery regime for employees who are on paid work, paid leave, unpaid leave, unpaid personal leave, and treatment for occupational accidents or employers and employees consent to only pay social insurance premiums for six months or increase the payment of social insurance premiums to an unusually high level during the six months before give births to enjoy maternity benefits.

Increased inspection to combat fraud and abuse of social insurance, health insurance and unemployment insurance funds. Illustrative Photo

Profiteer lump-sum insurance benefits in the form of authorisation

Taking advantage of the urgent need of certain labourers who request for one-off payout of social insurance benefits to overcome immediate difficulties, and of simple procedures for one-time social insurance withdrawal, some people have collected social insurance books of labourers in the form of pledge and authorisation (social insurance book holders make a document authorising others to carry out procedures for lump-sum social insurance withdrawal). This is a practice of social insurance book trading, which does not only cause great disadvantages for labourers because they receive only one-third or half of the actual value of the benefits but also puts pressure on the social security system in the long term.

Illustrative image (internet)

Abuse, profiteer unemployment insurance fund

While receiving unemployment allowance, labourers find a job (labourers signed a formal labour contract with employers) but do not report to the local Employment Services Centre.  After the unemployment benefit period expires, the labourers make dossiers to request the local social insurance office to collect compulsory payment of social insurance premiums for this period.

Abuse, profiteer health insurance fund

Health facility staff use the health insurance card of their relatives or use the number of the insured patient’s health insurance card who previously visited the facility for treatment or co-ordinate with “middle-men” to create fraudulent medical records, aiming to profiteer both life insurance and health insurance benefits (such as the case that recently occurred at Thai An General Hospital, Vinh Medical University Hospital in Nghe An Province).

In addition, there are other forms of abuse and exploitation of the health insurance fund such as: healthcare facilities manipulate and make incorrect payments for technical services; overstate the requested payment amount for medication beyond the actual quantity used; prescribe medication that is not appropriate for the diagnosed condition; provide unnecessary medical services for health insurance card holders, leading to the waste of the health insurance fund. As for patients, some borrow others’ health insurance card for medical examination and treatment or use their health insurance card multiple times to obtain medication for purposes other than their own treatment.

In light of the current situation, in order to strengthen the prevention and combat against the abuse and misappropriation of the social insurance, health insurance and unemployment insurance funds, the Vietnam Social Security (VSS) has been actively monitoring the situation and issuing directives, instructing social insurance offices to increase co-ordination with departments and sectors, especially investigation bodies to timely detect and deal with violations. Nevertheless, when detecting the aforementioned behaviours, the VSS only stops at the state of recovering or recommending competent authorities to resolve them. And solutions remains situational and are not strong enough to proactively stop and combat the abuse and misappropriation by origanisations and individuals.

Illustrative image (internet)

To help resolve the situation, besides efforts of the social security industry, it is crucial to have the guidance and directions from the Ministry of Labour, Invalids and Social Affairs, Ministry of Health and People’s Committees of Central-levelled provinces and cities. Accordingly, VSS recommends the labour ministry to further strengthen inspection into units that delay the payment of social insurance, health insurance and unemployment insurance premiums and work with social security offices to strengthen the review and share of data to prevent labourers from enjoying unemployment benefits illegally.

The Ministry of Health should enhance directions in the co-ordination for inspection and examination of the health insurance-based medical examination and treatment as well as the settlement of health insurance-based medical costs; and timely tackle the misappropriation of health insurance cards by medical facilities and patients.

People’s Committees of Central-levelled cities and provinces should direct competent State management bodies to increase inspection and supervision of bodies, units and businesses located in their respective localities in implementing laws on social insurance, health insurance and unemployment insurance./.