Social Security Urges Members to Check Medical Records for Fraud
Social Security Office urges members to verify their medical records via the Doctor Ready app and report any unauthorized treatment claims or unfamiliar facility visits to hotline 1506, as fraud investigations cannot begin without member co
On July 30, 2025, Dr. Suradej Waliitthikul, chairman of the Medical Board at the Social Security Office (SSO), revealed that multiple insured members discovered medical service records—including diagnoses and medication dispensing—at facilities they had never visited when checking the 'Doctor Ready' application. He explained that such cases must first distinguish between types of coverage: if the services are health checks or health promotion services (PP) provided to all Thais under any insurance scheme, responsibility falls to the National Health Security Office (NHSO), not the SSO. In cases involving actual medical treatment under SSO coverage—particularly emergency treatment outside the member's home area—members who suspect unauthorized use of their benefits should immediately report it to the SSO, as improper claims constitute fraudulent billing. Dr. Suradej noted that the SSO system cannot directly access members' personal data due to privacy laws, so insured persons must initiate requests to verify whether claims have been filed under their national ID number. If claims are found despite the member never receiving treatment, this triggers a formal investigation. When asked about the large number of people preparing complaints after finding treatment records for conditions at hospitals outside their SSO coverage in the app, Dr. Suradej explained that emergency treatment at other facilities can occur legitimately and be billed to the SSO. However, if members report discrepancies and fraudulent billing is confirmed, the SSO will immediately send investigation teams to the relevant service providers to examine documents and evidence. He emphasized that member reports are valuable for stopping such schemes. If a member confirms never receiving treatment yet finds a claim filed, the SSO dispatches investigators and, if systemic irregularities or repeated emergency billing anomalies are found, expands the investigation across the entire service provider system. Dr. Suradej urged members who discover irregularities to contact the hotline 1506 or submit evidence directly to the SSO for swift investigation, since without complaints from rights holders, the office cannot know if benefits have been misused.
