Forgery of documents fraud, detention!Guangdong exposed 10 typical cases of fraudulent insurance

The medical security fund is the "seeing money" and "life -saving money" of the people. Its use of the safety involves the vital interests of the masses and the healthy development of the medical security system.

In order to severely crack down on fraudulent insurance, the Guangdong Provincial Medical Insurance Bureau notified 10 typical cases of fraud insurance, involving illegal and illegal acts such as fake medical documents fraud, hanging bed hospitalization, medical treatment, over -diagnosis, super standard charges, skewer diagnosis and treatment project charges and other illegal acts and regulations Some of them were detained by administrative detention and took a look.

Case number one

Case of violations of Health Station, Lianxia Town, Lianxia Town, Chenghai District, Shantou City

During the special inspection of the medical insurance department of Shantou City, it was found that there were illegal situations such as fake medical insurance prescriptions, fictional diagnosis and treatment services, fictional consulting services, fake outpatient medical records, etc., which were in the Health Station of Lianxia Town, Chenghai District, Shantou City. Essence

According to the "Regulations on the Supervision and Administration of the Medical Security Fund", the Shantou Medical Insurance Bureau made the following processing of the institution: ordered rectification; 18,100 yuan of medical insurance funds for the fraud, and a fine of 36,200 yuan; Service agreement; report the situation of the medical insurance agency, and the medical insurance agency has dealt with the institution to terminate the designated service agreement of the medical insurance designated service agreement in accordance with the medical insurance service agreement.

Case 2

Foshan City Liu Mouhua is suspected of fraudulent insurance cases

According to the clue of the Social Security Bureau of Chancheng District, Foshan City, after investigation by the Foshan Medical Insurance Bureau, the insured Liu Mouhua had the opportunity to enjoy the treatment of specific diseases for outpatient clinics, and at the First People's Hospital of Foshan, Foshan Fosun Zencheng Hospital, Foshan City Co., Ltd. prescribed medicines for many times and resold the drugs for profit, involving 164,000 yuan in medical insurance funds.

According to the "Regulations on the Supervision and Administration of the Medical Security Fund" and "Social Insurance Law of the People's Republic of China", the local medical insurance department transferred the clue to the public security department to investigate and deal with it.

Case II

Violation of Yingxin Branch, Shunde District, Shunde District, Foshan City

According to the clues of the masses, after investigation by the Foshan Medical Insurance Bureau, it was found that the Yingxin Branch of the Yingxin Branch of the Yingxin Branch of Longjiang Town, Longjiang Town, Shunde District, Foshan City provided illegal situations for the use of medical insurance cards to purchase daily necessities, involving medical insurance funds of 07,600 Yuan.

According to the "Regulations on the Supervision and Administration of the Medical Security Fund", the Foshan Medical Insurance Bureau made the following processing of the institution: ordered to refund the medical insurance fund of 07,600 yuan; double the fine of 07,600 yuan; the termination service agreement for medical insurance.

Case Four

Heyuan Chang'an Hospital Violation Case

According to the transfer of clues to the Provincial Medical Insurance Bureau, after investigation by the Heyuan Medical Insurance Bureau, it was found that there were illegal conditions such as over -diagnosis and treatment, over -examination, and super -standard charges in Chang'an Hospital of Heyuan City.

According to the "Regulations on the Supervision and Administration of the Medical Security Fund", the Heyuan Municipal Medical Insurance Bureau made the following processing of the institution: RMB 14,400 for the return of the medical insurance funds that violate the settlement;

Case 5

Case of illegal case of Dongguan Kanghua Hospital

During the special inspection of the Dongguan Medical Insurance Bureau, it was found that the Kanghua Hospital had illegal conditions such as super standard charges, repeated charges, and stringing projects from May 1, 2021 to February 10, 2022, involving the medical insurance fund 2.51 million yuan Essence After the incident, Kanghua Hospital took the initiative to conduct self -examination and self -correction and returned a total of 11.84 million yuan in medical insurance funds involved in the case.

According to the "Regulations on the Supervision and Administration of the Medical Security Fund", the Dongguan Medical Insurance Bureau fined the institution with a fine of 2.51 million yuan in the medical insurance fund involved in the case.

Case 6

Case of violations of Jiangmen City Taoyuan Taoyuan Pharmacy

Jiangmen City Heshan Medical Insurance Bureau and the Heshan Social Security Bureau conducted on -site inspections, and found that there were illegal situations such as induction, assisting others, or false medical treatment, medical materials, and providing false certification materials such as Taoyuan Zhongsheng Pharmaceutical Store in Heshan City.

According to the "Regulations on the Supervision and Administration of the Medical Security Fund" and "Administrative Measures for the Basic Medical Insurance of Jiangmen City", Jiangmen Heshan Medical Insurance Bureau and the Heshan Social Security Bureau made the following processing of the institution: Return to the amount of fraud at 0.03 million yuan; a fine of 0,06 million fines of 10,600,000 Yuan; lifting medical insurance designated service agreement.

Case Seven

Case of violations of Suxi Chengnan Hospital, Zhanjiang City

Zhanjiang City obtained clues during special inspections. After investigation, it was found that Zhanjiang Suixi City South Hospital had illegal conditions such as hanging bed hospitalization, false condition, altering forgery of medical documents, and over -treatment, involving 747,000 yuan in medical insurance funds.

According to the "Regulations on the Supervision and Administration of the People's Republic of China" and "Regulations on the Supervision and Administration of the Medical Security Fund", Zhanjiang Medical Insurance Bureau made the following processing of the institution: order rectification; ordered 747,000 yuan in medical insurance funds to be returned to illegal settlement; ; Suspend the medical insurance service agreement for 1 year.

Case 8

Zhanjiang Suixi Hanping Traditional Chinese Medicine Hospital violation case

Zhanjiang Medical Insurance Bureau obtained clues during special inspections. It was found that there were illegal and violations of low standards, fake diseases, fake medical records, replication and transformation medical documents, over -standard charges, etc. , Involved 679,000 yuan in medical insurance funds.

According to the "Regulations on the Supervision and Administration of the People's Republic of China" and "Regulations on the Supervision and Administration of the Medical Security Fund", Zhanjiang Medical Insurance Bureau made the following treatment: order rectification; ordered 679,000 yuan in medical insurance funds to be returned to illegal settlement; ; Suspend the medical insurance service agreement for 1 year. Case Nine

Zhong Mouqing forged medical documents fraudulent cases

According to the transfer clue of the Qingcheng Branch of the Qingyuan Social Security Bureau, after investigation, it was found that Zhong Mouqing drove two rounds of motorcycles to carry a traffic accident with Lin Moulan. The medical expenses shall be reimbursed in violation of regulations, involving 170,000 yuan in medical insurance funds.

According to the "Public Security Management Punishment Law of the People's Republic of China" and other regulations, the Qingyuan Medical Insurance Bureau transferred the case to the public security organs for treatment, and the local public security organs were detained in the administrative detention of Zhong Mouqing for 5 days.

Case Ten

The case of violations of laws and regulations in Huaiji County Hospital of Zhaoqing City

According to the clues of the masses, it was investigated by the Guangdong Provincial Medical Insurance Bureau and found that there were illegal and violations of the medical expenses such as the breakdown project charges, excessive inspection, and the medical expenses that did not belong to the medical insurance fund payment scope of the medical insurance fund. A medical insurance fund is 107,800 yuan.

According to the "Regulations on the Supervision and Administration of the Medical Security Fund", the Guangdong Provincial Medical Insurance Bureau made the following processing of the institution: the institution was ordered to return 107,800 yuan of medical insurance funds for illegal settlement; Medical services involved in medical insurance funds.

Maintain the safety of medical insurance funds

Everyone is responsible

If you find fraudulent behavior

Please report to the local or higher -level medical insurance department in time

"Safe Money" for protecting the people together

Edit | Editor of Yin Yan | Zhang Xiuli

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Source | Guangdong Medical Security Bureau

Produced by Guangdong Health Online All -Media Team

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