China News Service, February 24. According to the news on the website of the National Medical Insurance Administration on the 24th, the National Medical Insurance Administration announced that the first phase of 2021 will expose a total of 9 typical cases.
Including the case of insurance fraud by Jinjing Hospital in Jinzhou City, Liaoning Province, the case of insurance fraud by Chunwang Hospital in Wangchengpo, Changsha City, Hunan Province, and the case of Zeng XX fraud and insurance fraud by the Chinese Medical Department of Qiliping Town Central Hospital, Hong'an County, Huanggang City, Hubei Province, etc. Details are as follows:
1. The case of fraud and insurance by Jinjing Hospital in Jinzhou City, Liaoning Province
After a joint investigation by the Jinzhou Municipal Medical Insurance Bureau and the Public Security Bureau, it was discovered that Huang Moumou, the president of Jinjing Hospital, and many people inside and outside the hospital used the medical insurance card of employees, residents, and students to apply for a false hospitalization in the medical insurance system of Jinjing Hospital, defrauding the medical insurance fund of 290,683.15 yuan. The illegal facts of the case, all the illegal funds of 290,683.15 yuan in the case were recovered and returned to the fund account of the Medical Insurance Center.
The local court heard and decided as follows: 1. The defendant Huang Moumou, the president of Jinjing Hospital, committed fraud and was sentenced to 8 years and 8 months in prison and fined RMB 500,000; 2. The defendant Tian Moumou, The legal person of Jinjing Hospital, guilty of fraud, was sentenced to 9 years’ imprisonment and fined RMB 500,000; 3. The defendant Xu Moumou, a doctor at Jinjing Hospital, committed fraud and was sentenced to 7 years and 3 months’ imprisonment, and A fine of RMB 300,000; 4. The defendant Duan, a financial officer of Jinjing Hospital, committed fraud and was sentenced to 5 years and 6 months in prison and fined RMB 250,000; 5. The defendant Yang, An employee of Jinzhou Jiutai Pharmaceutical Co., Ltd. committed fraud and was sentenced to 4 years in prison and fined RMB 150,000; 6. The defendant Han Moumou, a teacher at Liaoning Petrochemical Vocational and Technical College, committed fraud and was sentenced to fixed-term imprisonment Three years, suspended for three years, and fined RMB 50,000.
2. The case of fraud and insurance by Chunwang Hospital in Wangchengpo, Changsha City, Hunan Province
After investigation by the Changsha Public Security Bureau and the Medical Insurance Bureau, it was discovered that Li XX, the vice president of Changsha Wangchengpo Chunwang Hospital, and the dean and legal person Liu XX, fraudulently obtained medical insurance funds in terms of drugs, laboratory tests, and Chinese medicine package treatment. The fact of RMB 4,253,947.38.
The persons involved in the case, Li Moumou and Zhu Moumou, have respectively refunded the illegal income of RMB 2 million and RMB 100,000 to the Changsha Medical Security Affairs Center. The remaining illegal funds of RMB 2,153,947.38 have also been returned to the Changsha Medical Security Affairs Center.
The court verdict was as follows: Liu Moumou and Li Moumou defrauded the National Medical Insurance Fund, the amount of which was extremely large, and their actions constituted the crime of fraud. Liu Moumou was sentenced to 10 years in prison and a fine of RMB 100,000; A certain sentenced to 3 years in prison, suspended for 5 years, and fined RMB 70,000.
3. Case of fraud and insurance by Yikang Chinese Medicine Hospital, Heshuo Silk Road, Heshuo County, Heshuo County, Xinjiang Uygur Autonomous Region
The Heshuo County Medical Insurance Bureau of Bayingoleng Mongolian Autonomous Prefecture conducted an investigation based on the clues of the report and found that Yang Moumou, the legal person of Heshuo Silk Road Yikang Traditional Chinese Medicine Hospital, had illegal facts such as forging medical records, lowering standard hospitalization, inflating expenses, and abusing antibiotics. , Suspected of illegal use of medical insurance amount of 104,400 yuan.
After the case was transferred to the public security, the person involved in the case Yang Moumou was detained by the public security on suspicion of fraud. All illegal proceeds were recovered and returned to the fund account of the Medical Insurance Center.
The judgment by the local court was as follows: the defendant, Yang Moumou, a legal person of Heshuo Silk Road Yikang Traditional Chinese Medicine Hospital, committed fraud and was sentenced to three years in prison, suspended for five years, and fined 100,000 yuan.
4. Case of Zeng Moumou's fraud and insurance deception, Qiliping Town Central Hospital, Hong'an County, Huanggang City, Hubei Province
After a joint investigation by the Hong'an County Medical Insurance Bureau and the Public Security Bureau, it was discovered that Zeng Moumou, an employee of the National Medical Hall (Rehabilitation Treatment Department) of the Qiliping Town Central Hospital, was fraudulently obtained by forging medical records from August 1, 2018 to May 25, 2019. The facts of the medical insurance fund, the illegal proceeds of the case were recovered and returned to the medical insurance center fund account.
The court heard the verdict: the defendant Zeng XX was guilty of fraud, the amount of fraud was 264,927.12 yuan, and he was sentenced to three years and six months in prison and a fine of 100,000 yuan.
5. Corruption case of Nian XX, former medical insurance administrator and pharmacy fee collector of Liujiaying Township Health Center, Fengrun District, Tangshan City, Hebei Province
After investigation by the Medical Insurance Bureau of Fengrun District, Tangshan City, Nian Mo, a medical insurance specialist and pharmacy fee collector at Liujiaying Township Health Center, was suspected of defrauding medical insurance funds by falsely reporting hospitalization information during 2018.
After the case was transferred to the public security department, the public security department further investigated and fixed relevant evidence, determined the above illegal facts, and recovered 44884.65 yuan of illegal proceeds.
The local court heard and decided as follows: Defendant Nian XX was sentenced to seven months imprisonment, suspended for one year, and fined RMB 100,000 on suspicion of corruption.
6. Case of fraud and insurance by villager Li Moumou, Bakenzhong Village, Yikenzhong Township, Ningcheng County, Chifeng City, Inner Mongolia
After investigation by the Ningcheng County Medical Insurance Bureau of Chifeng City, the insured Li Moumou had used the medical insurance fund to reimburse medical expenses of 38964.66 yuan (the cost should not be paid by the medical insurance fund) from 2017 to 2019 by deliberately concealing third-party liability. In fact, suspected of fraud and insurance.
On April 2, 2020, the local court decided as follows: Defendant Li Moumou committed fraud and was sentenced to one year and six months in prison, suspended for two years, and the defendant Li Moumou’s illegal proceeds of 38964.66 yuan were returned to the Medical Insurance Center. Fund account, and fined RMB 5,000.
7. Case of fraud and insurance by Zhu Moumou in Lianyungang City, Jiangsu Province
After investigation by the Lianyungang Medical Insurance Bureau, the insured person Bi Moumou's daughter-in-law Zhu Moumou had a joint doctor Jiang Moumou deliberately concealed the third-party liability and used the medical insurance fund to reimburse medical expenses of 22,859.82 yuan (the cost) Should not be paid by the medical insurance fund), suspected of fraudulent insurance.
After the case was transferred to the Haizhou Public Security Bureau of Lianyungang City, it was verified that the above circumstances were true.
The judgment by the local court was as follows: the defendant Zhu Moumou committed fraud and was sentenced to six months in prison, suspended for one year, and fined RMB 20,000 and returned RMB 22,859.82 to the fund account of the Medical Insurance Center.
8. Case of insurance fraud by Yang Moumou, a participant in Lai'an County, Chuzhou City, Anhui Province
After investigation by the Medical Insurance Bureau of Lai'an County, Chuzhou City, the insured Yang Moumou was suspected of defrauding medical expenses of 155,000 yuan by deliberately forging 3 hospital invoices to prepare medical insurance reimbursement.
After the case was transferred to the police, it was verified that the above situation was true.
The local court decided as follows: The defendant Yang XX committed fraud (attempt) and was sentenced to three years in prison, suspended for three years, and fined 20,000 yuan.
9. The case of embezzlement of public funds by Yang from the Medical Insurance Management Center of Pu'er City, Yunnan Province
An investigation by the Pu'er Medical Insurance Bureau found that Yang Moumou, the former chief of the Financial Statistics Department of the Pu'er Medical Insurance Center, was suspected of embezzling medical insurance funds.
The clues of the case were transferred to the Pu'er Municipal Commission for Discipline Inspection and the police for further investigation, the evidence was locked, all illegally obtained funds were recovered and returned to the fund account of the Medical Insurance Center.
The judgment by the local court is as follows: Yang Moumou, the former chief of the Financial Statistics Division of Pu'er Medical Insurance Center, embezzled public funds of RMB 947,836.89, which constituted the crime of embezzling public funds and was sentenced to two years in prison and two years of probation.