China News Service, March 26. According to the website of the National Medical Insurance Administration, the National Medical Insurance Administration announced on the 26th that the second phase of 2021 exposed typical cases, with a total of 10 cases.
Cases include the illegal use of medical insurance funds by the Zibo Mental Health Center in Shandong Province, the fraud and insurance case of Qingxi Youhua Hospital in Dongguan City, Guangdong Province, and the fraud and insurance case of Boai Geriatric Hospital in Mudanjiang City, Heilongjiang. The details are as follows:
1. Case of illegal use of medical insurance funds by Zibo Mental Health Center, Shandong Province
According to the investigation by the Zibo Medical Insurance Bureau, it was discovered that the Zibo Mental Health Center (Fifth People's Hospital) used medical insurance funds in violation of regulations by inducing the insured person to stay in bed, involving RMB 34,269.30.
The local medical insurance department handled the following: 1. Recover the medical insurance funds used by Zibo Mental Health Center in violation of regulations; 2. Request the hospital for rectification within a specified time; 3. Impose an administrative fine of 171,346.50 yuan on the hospital.
At present, the 34,269.30 yuan of medical insurance funds used by the hospital in violation of regulations have been fully recovered, and all administrative fines have been paid to the account.
2. Fraud and insurance case of Qingxi Youhua Hospital in Dongguan City, Guangdong Province
After investigation by the Dongguan Medical Insurance Bureau, it was discovered that Dongguan Qingxi Youhua Hospital was suspected of defrauding the insured person to apply for admission through a "free medical examination", and fraudulently obtaining medical insurance funds by forged medical documents and false diagnosis and treatment services, involving 139,817.40 yuan.
The local medical insurance department handled the following: 1. Recover the illegally obtained medical insurance funds; 2. Transfer the case to the public security department for further processing.
At present, the medical insurance fund of 139,817.40 yuan illegally obtained by Qingxi Youhua Hospital has been recovered.
After the case was transferred to the public security, the third People’s Procuratorate of Dongguan has filed a public prosecution with the local court, and it is under further trial.
3. Case of Fraud and Insurance by Bo'ai Geriatric Hospital in Mudanjiang City, Heilongjiang
After investigation by the Harbin Medical Insurance Bureau, it was discovered that the Dakang Hospital of Traditional Chinese Medicine in Shuangcheng District, Harbin City was suspected of fraudulently obtaining medical insurance funds by falsifying medical records and swapping items, involving 97969.03 yuan. A variety of drugs ("Cefoperazone Sodium and Sulbactam Sodium for Injection" "Omeprazole injection", "Osseopeptide injection", etc.) have violations such as over-limit payment of medical insurance, involving RMB 72,081.75.
The local medical insurance department handles the following: 1. According to the agreement, recover the medical insurance funds obtained and used illegally; 2. Dissolve the medical insurance fixed-point service agreement of Shuangcheng Dakang Traditional Chinese Medicine Hospital, and notify the violation; 3. Transfer the case to the public security Further processing by the department.
At present, the hospital's medical insurance funds of 17,050.78 yuan in violation of laws and regulations have all been recovered.
IV. Case of fraud and insurance in Hongtai Hospital, Nong'an County, Changchun City, Jilin Province
An investigation by the Medical Insurance Bureau of Nong’an County in Changchun City revealed that Hongtai Hospital in Nong’an County was suspected of fraudulently obtaining medical insurance funds through forged medical records, false hospitalizations, and fake hospitalizations, involving 1058991.06 yuan.
The local medical insurance department handled the following: 1. Recover the illegally obtained medical insurance funds of Hongtai Hospital; 2. Dissolve the medical insurance fixed-point service agreement of Hongtai Hospital; 3. Transfer the case to the public security for further processing.
At present, the hospital's illegally obtained medical insurance funds of 1058991.06 yuan have all been recovered.
5. Case of illegal use of medical insurance funds by Shiqiao Town Health Center in Lu County, Luzhou City, Sichuan Province
According to the investigation by the Lu County Medical Insurance Bureau of Luzhou City, it was discovered that there were many illegal use of medical insurance in the Shiqiao Town Health Center, Lu County, including low-standard hospitalization, non-indicated medication, medication beyond the scope of indications, repeated inspections, package inspections, and over-standard charges. The financial behavior involved 345,039.84 yuan.
The local medical insurance department handled the following: 1. Recover the medical insurance funds obtained from the Shiqiao Town Health Center in Lu County; 2. Suspend the medical insurance services of the Traditional Chinese Medicine Physiotherapy Department of the hospital for 3 months; 3. Transfer the case to the Lu County Commission for Discipline Inspection and Supervision for further processing.
The Commission for Discipline Inspection and Supervisory Committee has investigated and dealt with the following: 1. Dean Yin Moumou received a warning from the party; 2. Vice President Tang Moumou received a serious warning from the party; 3. Doctor Liang Moumou and Xu Moumou received a serious party warning Warning processing; 4. Doctor Wang Moumou and Xu Moumou are subject to administrative records.
At present, the hospital's illegal medical insurance fund of 345,039.84 yuan has been recovered.
6. Fraud and insurance case of Huaren Integrated Traditional Chinese and Western Medicine Clinic in Xianju, Taizhou City, Zhejiang Province
An investigation by the Medical Insurance Bureau of Xianju County, Taizhou City revealed that the Xianju Huaren Integrated Traditional Chinese and Western Medicine Clinic in Xianju County was suspected of defrauding medical insurance funds through the use of medical insurance cards, false names, false entries, and cross-exchange projects, involving 145,673.18 yuan.
The local medical insurance department handles the following: 1. Recover the medical insurance funds illegally obtained by the outpatient department, and deduct the corresponding liquidated damages according to the agreement; 2. Dissolve the medical insurance designated service agreement of the outpatient department; 3. Transfer the case to the public security department for further processing.
At present, the hospital's illegally obtained medical insurance funds of 145,673.18 yuan have all been recovered, and the liquidated damages of 223648.76 yuan have been fully credited.
7. Case of fraud and insurance by Liu Moumou Yin Moumou, a resident of Yueyanglou District, Yueyang City, Hunan Province
After investigation by the Medical Insurance Bureau of Yueyanglou District, Yueyang City, it was discovered that residents Liu XX and Yin XX were suspected of reimbursing medical expenses through forged medical bills, defrauding medical insurance funds of 15,309.39 yuan and 27,146.79 yuan, respectively.
After the case was transferred to the police, the relevant evidence was further fixed and the above illegal facts were confirmed.
The local court heard the following judgments: 1. Defendant Liu XX committed fraud and was sentenced to one year’s imprisonment, suspended for one year and six months, and fined 3,000 yuan; 2. Defendant Yin XX committed fraud and sentenced to fixed term Imprisonment for one year and six months, suspended for two years, and fined 3,000 yuan.
At present, all the 42456.18 yuan of medical insurance funds obtained by Liu XX and Yin XX have been recovered.
8. The case of Liu Moumou, an insured person in Xiangning County, Linfen City, Shanxi Province who seeks medical treatment under false pretence
After investigation by the Xiangning County Medical Insurance Bureau of Linfen City, it was found that the insured Liu Moumou fraudulently used the insured resident Su Moumou's medical insurance card in the Xiangning County People's Hospital for medical reimbursement between May 30, 2019 and June 16, 2019. Fee, involving 168270.29 yuan.
The local medical insurance department handled the following: 1. Recover the medical insurance funds obtained by Liu Moumou illegally; 2. Deduct 841,351.45 yuan of liquidated damages from the Xiangning County People’s Hospital according to the agreement; 3. Order the hospital to rectify within a time limit; 4. Transfer the case to the public security department for further processing .
At present, Liu Moumou’s illegally obtained medical insurance funds of 168,270.29 yuan have all been returned, and the hospital’s liquidated damages of 841,351.45 yuan have all been credited to the account. The local discipline inspection and supervision organs and public security departments have filed the case and are in further processing.
9. Case of insurance fraud by Oumou, a participant in Zhangjiagang City, Jiangsu Province
An investigation by the Zhangjiagang Medical Insurance Bureau revealed that the insured Ou Moumou was suspected of defrauding medical insurance funds by frequently prescribing a large number of fixed types of prescription drugs at many designated hospitals in this city, involving RMB 1,780,32.28.
After the case was transferred to the public security department, the public security department further investigated and fixed relevant evidence and confirmed the above illegal facts.
The judgment by the local court was as follows: The defendant Oumou committed fraud and was sentenced to two years in prison, suspended for three years, and fined 10,000 yuan.
At present, the insured person's illegally obtained medical insurance funds of RMB 1,780,03.28 have all been recovered.
10. Case of insurance fraud by Xiao Moumou, an insured person in Qianshan City, Anhui Province
After investigation by Qianshan Medical Insurance Bureau of Anhui Province, it was found that the insured Xiao Moumou was injured in a traffic accident on December 10, 2018, and was admitted to the hospital for treatment. After receiving compensation for the traffic accident from the party responsible for the accident, his son Xiao Moumou was suspected of being involved in the accident. On April 28, 2019, for the purpose of illegally occupying medical insurance funds, through deliberately fabricating and concealing facts, falsely filling in the "Form of Injury of Participants", defrauding medical insurance funds of 34059.50 yuan.
The local medical insurance department handled the following: 1. Recover the medical insurance funds obtained by Xiao XX illegally; 2. Transfer the case to the public security department for further processing.
At present, the medical insurance fund of 34,059.50 yuan illegally obtained by the insured person has been fully recovered.