According to public reports, in 2065438+2008 1 year, a public hospital in Hefei, Anhui Province was exposed to the problems of defrauding medical insurance funds by swiping social security cards on behalf of patients and hanging up the bed for hospitalization. After investigation by the joint investigation team, it was determined that this was a serious violation of laws and regulations in the field of people's livelihood and had a great negative impact on society. Many responsible personnel in the hospital were held accountable.

In order to ensure the safety of medical insurance fund, in April 20 18, Anhui Province promulgated the Interim Measures for the Supervision and Administration of Basic Medical Insurance in Anhui Province. It stipulates that medical institutions and their personnel who have agreed to provide basic medical insurance medical services for the insured shall verify the basic medical insurance vouchers and identity certificates, and shall not provide excessive or irrelevant examination and treatment for the insured in violation of disease diagnosis and treatment routines and technical operating procedures, and shall not defraud the basic medical insurance fund by means of false hospitalization or false treatment.

The National Medical Insurance Bureau reported 8 typical cases of defrauding medical insurance funds on 20 19 1, among which many cases of defrauding medical insurance funds were investigated for inducing hospitalization. It was mentioned in the circular that Renai Hospital in Dazhou City, Sichuan Province induced patients to be hospitalized by exempting patients from paying their own expenses, picking up and dropping off vehicles, giving quilts and medicines when leaving the hospital, and defrauding the medical insurance fund of 90,300 yuan through various charges and false charges.

After verification, the qualification of the designated medical institution for medical insurance in this hospital was cancelled, and the practice license of the medical institution in this hospital was also revoked. The public security department arrested two people according to law, and 1 person was released on bail pending trial.

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In this regard, Yang Yansui, a professor at Tsinghua University Hospital Management Research Institute and director of the Employment and Social Security Research Center, believes that the hospital has zero threshold for hospitalization and treats patients with mild or even no symptoms. "It not only violates the operating rules of the hospital, but also violates the medical insurance system and is suspected of defrauding insurance."

In her view, this is some medical institutions fishing in troubled waters when the medical insurance system needs to be improved urgently. With the introduction of medical insurance intelligent monitoring system and the gradual improvement of agreement management and administrative supervision of designated medical institutions, the phenomenon of fraudulent insurance will be greatly reduced.

Xu Yucai, deputy director of the Health Bureau of Shanyang County, Shaanxi Province, who has worked in the health field for many years, said that the reason why the hospital was suspected of cheating insurance was related to the excessive expansion of beds in local medical institutions. "In recent years, with the national medical insurance flight inspection, the crackdown on the abuse of medical insurance funds has increased, and this phenomenon has been effectively curbed. If medical institutions have this kind of behavior, it is definitely a dead end. "

Beijing News-Many hospitals in Taihe, Anhui Province are suspected of defrauding insurance: there is no pathological "cerebral infarction", and some people are hospitalized 9 times a year for free.