Orthopedic surgery has always been an operation that consumes a lot of equipment. Some people need to implant strengthening equipment in the bones of the injured area after being injured. Some devices are very expensive because they need to be permanently placed in patients, and even need to be imported to buy them. And common consumables, such as splints, bandages, gypsum, etc. I believe many people have seen or used it. The consumption of these equipments is very high, and the equipments are relatively expensive. Therefore, in the three years from 20 17 to 2020, tongji hospital was able to rely on these high-priced consumables to defraud tens of millions of medical insurance funds, and even illegally used more than 90 million medical insurance funds.
The means used in this hospital are relatively common, but due to a long time, there are a large number of consumables reported in violation of regulations, so even through series charges, repeated charges, false charges and other means, a large number of medical insurance funds can be defrauded. The hospital will not only repeatedly register and report the used consumables, but also make false charges. Obviously, the price of equipment is not that high, but they will exaggerate the number of accounts, and the medical insurance unit will not strictly check the big hospitals, so it is easy to be cheated.
In addition, tongji hospital will report the unused medical devices in violation of regulations. Even if these devices have not been used on patients, or even purchased, the hospital financial side will make financial reimbursement for these devices under the order, which will add up to tens of millions of yuan of sky-high insurance fraud.