China News Service, July 10, according to the official WeChat news of the National Medical Insurance Bureau, the National Medical Insurance Bureau's exposure station on the 10th exposed the first case of fraudulent medical insurance fund typical cases. details as follows:
Case of fraudulently obtaining medical insurance fund from Renai Hospital in Yuncheng, Shanxi Province
According to an investigation conducted by the Yanhu District Medical Security Bureau in Yuncheng, Rencheng Hospital of Yuncheng defrauded the medical insurance fund of RMB 48,600 in 2018 through hanging bed hospitalization and fraudulent medical service charges. Yuncheng Salt Lake District Medical Security Bureau and Yuncheng Salt Lake District Medical Insurance Center are based on Article 87 of the Social Insurance Law of the People’s Republic of China and Chapter VIII, Article 68, Section 7 and Articles of the 2019 Service Agreement for Designated Medical Institutions Article 68, paragraph 1, refused to pay the hospital's medical insurance fund of 48,600 yuan, deducted the three-time penalty of 145,700 yuan, canceled the Yuncheng Ren'ai Hospital medical insurance service agreement, and transferred the case to the judicial organ for processing.
Heilongjiang Province Suihua City Wangkui County Huiqi Manchu Township Hospital Defrauded Medical Insurance Fund Case
After investigation by the Suihua City Medical Security Bureau, the health hospital of Huiqi Manchu Town in Wangkui County passed the fake medical record inspection report in 2018 and defrauded the medical insurance fund of RMB 200,600. At the same time, 17 medical records reviewed by medical experts were unfounded and the medical expenses 35,300 yuan of medical insurance funds were sold. Suihua Medical Security Bureau based on Article 87 of the Social Insurance Law of the People’s Republic of China, Article 22 of the Administrative Penalty Law of the People’s Republic of China, and “Regulations on the Transfer of Criminal Cases by Administrative Law Enforcement Organs” (Order No. 310 of the State Council) Article 3, order to return the medical insurance fund to RMB 241,300 and impose a double fine of RMB 482,600; report the case to the health department and transfer it to the public security organ.
Quzhou Quzhou Cardiovascular Disease Hospital Co., Ltd. in Zhejiang Province
According to the investigation by Quzhou Medical Security Bureau and Quzhou Medical Insurance Center, Quzhou Jiu'an Cardiovascular Hospital (Co., Ltd.) defrauded the medical insurance fund of RMB 1.4244 million from 2017 to 2019 by falsifying drugs and diagnosis and treatment items, and forging medical documents. Drug purchase and sales are inconsistent, physiotherapy registration management is not standardized, and reimbursement of medical insurance funds is 690,800 yuan; reimbursement of medical insurance funds for retired cadres through false records and swapping projects is illegal. Ten thousand yuan). Quzhou Medical Security Bureau, Quzhou Medical Insurance Center according to Article 87 of the Social Insurance Law of the People's Republic of China and Article 69, Article 73, and Article 7 of the Service Agreement for Designated Medical Institutions of Quzhou Basic Medical Insurance Article 18. The hospital is ordered to return the medical insurance fund with reimbursement due to falsified items and forged medical documents, and imposed a triple fine of 4.427 million yuan; ordered to return the reimbursement due to non-conformity in the purchase and storage of drugs, and irregular management of physical therapy registration The medical insurance fund was 690,800 yuan, and a double fine of 1,381,600 yuan was ordered, which was ordered to return 99,800 yuan of medical insurance funds for retired cadres; the hospital’s medical insurance fixed-point service agreement was canceled; Reported to the Municipal Public Security Bureau; informed the Quzhou Municipal Party Committee Veteran Cadres Bureau of the relevant situation; transferred the fraudulent record and exchange project involving retired cadres’ medical security funds of RMB 344,800 to the Lhasa City Veteran Cadres Bureau of the Tibet Autonomous Region; Quzhou City Health Commission.
Case of fraudulently obtaining medical insurance fund by Chengdong Branch of Peng Pai Memorial Hospital, Haifeng County, Shanwei City, Guangdong Province
After investigation by the joint inspection team of Shanwei City Medical Security Bureau, Shanwei City Social Security Bureau, Haifeng County Medical Security Bureau, Haifeng County Social Security Bureau, Chengfeng Branch of Haifeng Pengpai Memorial Hospital defrauded medical insurance funds of 351.4 thousand yuan through the exchange of project fees from 2016 to 2019 Yuan, the medical expenses that do not meet the medical insurance reimbursement requirements are included in the medical insurance violation declaration medical insurance fund 702,700 yuan. Haifeng County Medical Security Bureau and Haifeng County Social Security Bureau based on Article 87 of Chapter 11 of the “Social Insurance Law of the People’s Republic of China”, Article 27 of the “Regulations on the Administration of Medical Institutions” of the State Council, and “Site of Basic Medical Insurance of Shanwei City” Article 37 of Chapter 5 of the Service Agreement of Medical Institutions, ordered the return of the medical insurance fund of RMB 1.0541 million, and doubled the fine of RMB 0.7028 million to the hospital for the exchange of fees; the hospital carried out hemodialysis diagnosis and treatment activities beyond the scope of registration 2. The outpatient prescriptions are not indicated with reasons to extend the prescription dosage and the medical records are not standardized, etc., and are transferred to the health department for treatment.
Case of fraudulently obtaining medical insurance fund from Linxia Harmony Hospital in Linxia Hui Autonomous Prefecture, Gansu Province
After investigations by Gansu Provincial Medical Security Bureau, Linxia Medical Insurance Bureau, and Linxia Medical Insurance Bureau, Linxia Harmony Hospital defrauded the medical insurance fund of RMB 43,400 in 2019 through false medical records, low-standard admission, and other means. According to Article 87 of the Social Insurance Law of the People’s Republic of China, Linxia Prefecture Medical Security Bureau ordered the hospital to return a medical insurance fund of RMB 43,400 and imposed a triple fine of RMB 130,300; suspended the hospital’s 6-month medical insurance service agreement and ordered it Rectify immediately and transfer the case to Linxia Prefecture Public Security Bureau and Linxia Prefecture Commission for Discipline Inspection.