Liu did not want to pay for additional surgery, although his doctor insisted that it was essential. But he had been lying on the operating table for an hour and the anesthetic on his genitals was starting to wear off.
Meanwhile, the doctor had Liu where he wanted, refusing to complete the circumcision unless he agreed to shell out thousands of dollars for additional procedures.
Pressures amid surgery were just a way for medical staff at Ouya Men’s Health Hospital, a private clinic in northwest China, to convince hundreds of patients to buy expensive treatments and unnecessary, earning millions of dollars in illegal prescriptions.
Encouraged by loose regulation and shielded by a network of corrupt officials, the hospital committed blatant health fraud for four years, in a scandal that recalled public outcry over unscrupulous private clinics several years ago.
Experts said the Ouya hospital scandal shows how China’s tenuous approach to regulating profit-hungry healthcare providers continues to pose dangers to the public, at a time when the number of private hospitals are growing rapidly in the country.
Fake doctors and nurses
With its marble lobby and staff in starched white uniforms, Ouya looks like the tens of thousands of private hospitals that have sprung up across China in recent years.
The 200-bed facility in Yinchuan, the capital of Ningxia Hui Autonomous Region, opened in 2015 and offered treatment for male problems, such as sexually transmitted diseases and infertility.
But behind the impeccable facade hid a fraudulent operation, as court records and media reports show. To attract customers, the hospital’s communications department ran fake ads online and used search engine optimization to make sure more people saw them, according to a recent report from affiliate China Comment magazine. to the official Xinhua News Agency.
Posing as healthcare professionals, department staff held online chats with potential clients, using well-prepared scripts to assess their health issues, identity and income before encouraging them to do so. treat at the clinic.
Once there, the employees who presented themselves as doctors or nurses received patients for consultations. This was often a scam: a subsequent survey found that 42 out of 77 of these employees were not part of the official database of qualified health professionals and that most of those who were registered were registered in other hospitals, according to the report.
During the consultations, the employees conspired to distort or exaggerate the condition of the patients. Several former employees confessed to subjecting men with erectile dysfunction to “blood circulation tests” which diagnosed “extremely low blood supply” to the penis, according to China Comment. Sometimes nurses would put torn paper in urine samples and present them as evidence that patients had “severe inflammation of the prostate.”
Hospital staff even blackmailed patients on the operating table. In Liu’s case, the doctor in charge of his circumcision told him that he had a prostate problem and varicose veins in his penis, refusing to complete the procedure until Liu agreed to pay 58,000 yuan (48,000 R $) for additional work, according to the report.
But at least Liu’s circumcision was a recognized operation. According to China Comment, a subsequent investigation by health officials found that other surgical procedures offered by Ouya, including the so-called “nerve excision” and “reduced sensitivity of the glans,” were “illegal and fraudulent. “.
Such surgeries “would not have brought any benefit to the treatment of patients and would have opened wounds that could cause physical harm to them,” said Deng Chunhua, head of the urology department of Sun Yat University’s first affiliated hospital. sen in Guangzhou and one of China’s best-known men’s health experts in an interview with Caixin. “Yes [os procedimentos] were ineffective, they would also have caused significant psychological damage. “
Local authorities supported hospital counterfeiters in exchange for gifts and a hearty meal, according to a subsequent investigation by the Communist Party’s anti-corruption department in Yinchuan, which charged 13 people with corrupt matters with a “criminal gang malicious”.
China Comment has reported that some market surveillance authorities have helped Ouya evade wrongdoing complaints despite the fact that the market regulation department received more than 80 complaints between 2017 and 2019 on its utilities platform.
A court later ruled that Ouya had kept silent about some of the victims using threats and intimidation. Deng told Caixin that some of the men may have been too embarrassed to report their experiences.
“At some level, patients are reluctant to mention male or sexual health issues. On a deeper level, people who have been deceived rarely think that reporting will work.
Although local authorities eventually cracked down on Ouya’s illegal advertising and questionable business practices – even temporarily shutting down the business for “rectification” three times – the fraud continued for four years, until what local police open an official hospital investigation in 2019.
Last August, the court ruled that Ouya deceived 350 people, injured 69 people and illegally earned 100 million yuan (83 million reais).
During the trial, approximately 48 people were convicted of crimes including fraud, extortion and willful physical harm. All were sentenced to prison terms, the group’s leader, Su Yixiong, sentenced to 20 years in prison.
The experts interviewed by Caixin were surprised by the nature and extent of the infringements. “I really think these people are terrible,” said Zheng Xueqian, director of the Beijing Huawei law firm and a professor who advises the government on legal matters related to health. “I think they have tarnished the good reputation of our hospitals and the health industry.”
The Ningxia and Yinchuan Public Security Departments refused Caixin’s requests for comment. Efforts to contact Liu and other victims failed.
China’s rapidly growing private healthcare sector and its patched up regulatory system have helped create the conditions for sweeping examples of fraud like Ouya’s, experts told Caixin.
The country gained more than 1,100 private hospitals in the 12-month period that ended in October, bringing the total to 23,000, according to the National Health Commission. Private hospitals, including for-profit ones and those run by non-state entities for the good public, today are twice as numerous as their public counterparts, although experts say they represent far less of the half of all patient visits.
However, a series of scandals rocked private healthcare providers, most notably when the death of a student in 2016 was linked to deceptive online advertising of cancer treatments provided by a vast network of commercial healthcare providers. in the southeastern region of Putian.
The Ouya case is an “extension” of the problems associated with the Putien model and an “inevitable result” of an incomplete developmental industry, said Zhou Shenglai, director of the Special Committee on Disease and Health Management at the ‘Chinese Association of Hospitals.
Several legal and political experts told Caixin that while China has laws and regulations that subject public and private hospitals to the same level of oversight, political loopholes and inconsistent police often create opportunities for abuse in the community. private sector.
Government agencies typically inspect state-backed healthcare providers more rigorously than industry associations that excel at auditing business entities, Zheng said.
In addition, the governance of private health care providers is “intense in terms of planning and overall structure”, but remains “very weak in regulating the actual operations of the profession,” said Liu Jitong, professor of policy and management. of health at Peking University.
According to Zhou, a culture among regulators to neglect supervision until crises occur, also undermines the healthy development of the sector. “We have to stop giving punishments after the fact and prefer to manage things in advance and along the way,” he said.
Years after the Putian scandals rocked confidence in China’s private healthcare sector, politicians continue to debate how to contain the industry’s excesses.
The government has supported the growth of private providers as part of healthcare reforms that attempt to move from China’s historic planned system to one that offers safer, more efficient and more flexible coverage.
Liu Jitong offered a discussion on the nature of the private health sector and cautioned against its over-commercialization. “These hospitals should be for the public good, they are not businesses,” he said.
Zhou said that China’s future reforms should “further support and promote” the development of private and “socially managed” hospitals so that they ideally represent up to 60% of all patient visits, to “relieve the pressure on government and strengthen the dynamism of the private sector “. health providers ”.
He added that the country should tighten hospital inspections and liberalize rules that prevent doctors from working in multiple facilities at the same time, a move he said would fight fraudulent registration of medical professionals.
Several experts called for stronger and more systematic supervision of health care providers. Liu Jitong proposed to place all hospitals, private and public, under the general supervision of the Ministry of Health.
“Government regulations, including supervision and administration, should treat public and private medical institutions in exactly the same way,” said Gu Xinjiang, a professor at Zhejiang University specializing in health policy.