The medical insurance fund is our life-saving money for the country, and we have to rely on it for reimbursement of hospitalization.
And why do life-saving hospitals cheat insurance? Is the medical insurance fund really that gullible?
Today, we will talk to you about this topic. The main contents are as follows:
Hospitalization is the same as staying in a hotel, including accommodation and money! How should the country act when medical insurance cheats the industrial chain? Who did the "fake patients" hurt in the end because they were greedy and cheap? First, the hospital cheated insurance, including eating, drinking and money. The hospital has become a hotel, with food and clothing and free physical examination. The "patients" are not lying on the infusion, but chatting and playing poker around the hospital bed. ...
An old man said, "How's it going? Being bored at home is hospitalization, just like playing. "
Does this sound ridiculous? But it does exist!
According to media reports, at least three hospitals in Taihe County, Anhui Province have recruited people who are free of illness or mild illness.
These hospitals have grasped the psychology that the elderly want to get free physical examination and maintain their health, and the elderly registered in hospital have become the tools for hospitals to defraud medical insurance funds.
When handling hospitalization procedures, medical staff will fabricate false medical records for the elderly, such as making a healthy old man into a cerebral infarction patient.
Obviously, these old people are just routine examinations, but there will be some "fictional items" on the discharge list.
This will cost thousands of dollars for medical insurance. The actual cost of treatment in the hospital is very low, so you can give "patients" some vitamins.
Not only that, the medical staff also took the initiative to send out invitations to let the old people mobilize more relatives and friends, introduce people to "hospitalization", and there will be a commission of two or three hundred yuan!
Even, the local government has specially developed an institution for "collecting the elderly". Every time 1 elderly person goes to the hospital, the institution can get several hundred yuan from the hospital.
Old people who want to be hospitalized will have a shuttle bus as long as they call the intermediary. Even for foreigners, intermediaries can borrow local ID cards and arrange hospitalization under pseudonyms, which is almost shaped? A complete "industrial chain" of medical insurance fraud!
Second, medical insurance fraud emerges one after another, how to break it? Many hospitals in Taihe, Anhui Province defrauded the medical insurance fund, which was really irritating, and the local government quickly launched an investigation. At present, the hospitals involved have been suspended from medical insurance reimbursement.
65438+February 18, the National Medical Insurance Bureau and National Health Commission jointly issued a document, demanding a heavy blow to strengthen medical insurance supervision.
In fact, similar insurance fraud is not the first time:
From 20 17 to 20 18, anzhen hospital, Changchun City, Jilin Province defrauded the medical insurance fund of 1688700 yuan by obtaining a medical insurance card for false hospitalization and inflating medical insurance expenses. During the period from 20 17 to 20 19, Jiu 'anxin Vascular Hospital in Quzhou City, Zhejiang Province defrauded the medical insurance fund of 1424400 yuan by falsely recording drugs and medical treatment items and forging medical documents. 20181-June, Renai Hospital in Dazhou City, Sichuan Province induced patients to stay in hospital by exempting out-of-pocket expenses, picking up cars, giving quilts and medicines, and defrauded the medical insurance fund of 90,300 yuan. 20 18 1- 12, Friendship Hospital of Yaodu District, Linfen City, Shanxi Province defrauded the medical insurance fund of 657 10000 yuan by falsely listing examination fees and physical therapy items. So, what happened to these hospitals that defrauded the medical insurance fund?
Take 20 18 Renai Hospital in Dazhou City, Sichuan Province as an example, the illegal expenses of 90,300 yuan were finally recovered by the Medical Insurance Bureau, and the hospital was fined 45 1500 yuan for five times, and the qualification of the hospital as a designated medical insurance institution was cancelled. The Public Security Bureau also arrested two people according to law, and 1 person was released on bail pending trial.
Mills of God grind slowly but sure. Liars try their best to cheat medical insurance money by various means, but any behavior that violates the law and harms the interests of ordinary people will eventually be punished by national laws.
Third, the medical insurance fund is actually a cash cow for scammers? The medical insurance fund, which was supposed to be "life-saving money" for ordinary people, was made into a "one-book-all-profit" business. When these plots, which are more magical than TV series, are exposed, it is incredible.
It is illegal and criminal to defraud the medical insurance fund, and the hospital can't be unaware of it. But money makes the mare go, and the lack of supervision opens the Pandora's box of human nature, and profiteering drives them to take risks.
How does it "work"? For example.
The medical insurance center allocates a medical insurance reimbursement quota to the hospital every year. Suppose that the hospitalization expenses of patients can be reimbursed to 900 yuan by medical insurance, and the 900 yuan will be paid to the hospital by the medical insurance bureau.
If only a few patients are hospitalized, the hospital is equivalent to guarding this "medical insurance quota" gold mine and cannot achieve profitability.
"The money given by the state is not spent", so some hospitals with ulterior motives designed these fancy scams:
Organize the elderly to be hospitalized healthily, and give the intermediary and the elderly 200 yuan "hard money". The hospital made a net profit in 700 yuan for itself, but the medical insurance fund was consumed in 900 yuan for no reason!
Moreover, even if it is found to be fraudulent, it will only cancel the qualification of medical insurance designated hospitals at most, which has little deterrent effect, so it has been repeatedly banned.
I don't know how you feel when you see this place.
The state has invested a lot of financial resources in the medical insurance fund, and we "laborers" are also contributing our strength every month. However, these "life-saving money", which are highly anticipated by ordinary people, have become "cash cows" in the eyes of fraudulent hospitals.
According to statistics, in 20 19, the losses caused by fraud in the national medical insurance fund reached 95.3 billion yuan. ......
But the good news is that the illegal cost will not be so low in the future. On February 9, 65438, the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds (Draft) was promulgated, which clearly increased the punishment for defrauding medical insurance. When necessary? Revocation of medical practice qualification.
This move is still powerful. I hope that fraudulent insurance can be severely punished, and the money from the medical insurance fund should be used in the cutting edge.
Fourth, the fake patients are greedy and cheap, who will ultimately hurt? Hospital insurance fraud is nothing new. If you have read the terms of some insurance products, you will find? Some hospitals were hacked by insurance companies.
According to the terms of a million-dollar medical insurance, all hospitals in Pinggu District, Huairou District and Miyun County in Beijing cannot reimburse medical expenses.
This is because these hospitals have a black history of collective insurance fraud.
And those elderly people who are deceived and sent to the hospital, whether they are greedy for "free medical examination" or earning "hard money", are just pawns of others.
They don't know that this kind of behavior may bring them great trouble.
The most serious thing is that my medical insurance card has been forged with hospitalization records and medical insurance funds. Suspected of fraudulent insurance.
Article 88 of the Social Insurance Law stipulates that: if the social insurance benefits are defrauded by fraud, forged certification materials or other means, the social insurance administrative department shall order the social insurance benefits defrauded to be returned and impose a fine of more than 2 times and less than 5 times the amount defrauded.
If you want to buy commercial insurance in the future, these false medical records (such as cerebral infarction, diabetes, etc. ) may lead to refusal of insurance and compensation.
In addition, some elderly people will cash out their medical insurance cards through drug dealers, which is not only illegal, but also uneconomical.
The price charged by drug dealers is much lower than the market price, which is equivalent to giving away hard-earned money at a discount. If you go to see a doctor yourself, there is not enough money in the medical insurance card, and you have to pay for it yourself. ......
After such an inventory, the scam that the elderly are easy to fall into, following telephone fraud, health care products lectures and so on. There is also a "medical insurance card abuse".
This can't help but make people think, is it because we have too little company with our parents, so they are bored and busy in the hospital? We didn't tell them the harm of the abuse of medical insurance card, which will turn into "ignorance" in our eyes. ......
If the medical insurance fund doesn't work well, it will hurt the interests of all of us.
China's medical insurance professional supervision still has a long way to go. Everyone should tighten the string of "cheating against the law" and not become an accomplice to cheating.