Blockchain can avoid fraud claim of China’s National Healthcare System
The New Rural Cooperative Medical System is China’s most important and fundamental social medical insurance mechanism for rural people. However, there are already many cases being reported where people have claimed the compensation by faking invoices and documents needed even these documents would undergo verification process.
This article is going
to explain that how Blockchain technology as a solution can helpavoid such frauds.
The Claim process for of NRCMS
See a doctor in a different city—obtaining proof of hospitality and invoices needed—obtaining initial approval from town-level hospital—reexamination at the NRCMS office in the prefecture—claim from local financial department
A staff for reviewing documents: This is correct one, pointing at the fabricated documents
Major means of insurance fraud
1.Cheater submits ID to an agency
2.The agency will collude and fabricate all the needed documents including medical report, diagnosis & operation proof and invoices. The medical information on these documents are a duplicate of other real patients.
3.The cheater applies for claim with fabricated documents at the Prefecture-level financial office. As there is great number of patients applying for claim with their treatment at different places, the reviewer can hardly identify the fraudulent cases.
1.The claim process is “multiple read” operation
2.The information leak of real patients is the root cause
3.The authenticity of data is the most urgent need.
The nation-level database that can collect all the medical information of all hospitals as problematic considering the risk from hack attack, network breakdown and manipulation from centralized nodes(like from administrator). Then here is the logic for how Blockchain can fundamentally change the situation.
1.When treating patients, doctors at the hospital enter the medical information in the Blockchain with timestamp and proof of origin(PoO).
2.Each hospital needs to maintain a node respectively. Each province needs to maintain a node. The staff at NRCMS official can directly read the data from the Provincial-level nodes instead of from those of hospital.
3.As the medical information of the patients are recorded step by step on Blockchain, it will be hard for the cheater to fabricate medical information. For example, it will take the cheater one month to fake a 1-month-long hospitality then the possibility to find out the cheater will be higher.
4.The medical information is recorded separately by different departments of the hospital based on their function. Like Operation Room record surgery information, drugstore record pill treatment information while the financial office records the invoice information. To fabricate document, the cheater needs to collude with different departments, which is much harder than the current situation.
5.The information on Blockchain is hash-encrypted so that staff at NRCMS office and lock Financial Office can verify the case simply via patients’ IDs.
6.The Blockchain solution can easily be integrated to other systems like those of commercial insurance company.