The time of insurance fraud has been repeated, malicious health insurance fraud cheated away how much health insurance money? The real sick people and how should be embarrassed? Upon investigation, we found that many fraudulent insurance incidents are more learned from the health center. For the health insurance reimbursement strategy, I just happened to organize the relevant content, I hope to help you: 2020 national social security health insurance application reimbursement process!
Recently, an off-site fraud health insurance nest case in Shanghai Zhabei District People's Court judgment. "This is a case of a very bad nature and a very big impact." Chen Jinjiang, deputy director of the Shanghai Health Insurance Supervision and Inspection Institute, told the First Financial Daily.
According to the criminal verdict of the Shanghai Zhabei District People's Court, the defendant, Li Chenghua, formerly the director of the Tianxing Health Hospital in Taixing City, Jiangsu Province, authorized several doctors and financial staff of the hospital from 2009 to issue false "Summary of Hospitalization Expense Details," "Charge Receipts," and "Discharge Summaries" for 42 Shanghai health insurance participants, who in turn used these The aforementioned medical insurance participants then used these bills to fraudulently reimburse medical expenses of approximately 1 million yuan to a number of medical insurance (assured) service centers*** including the Zhabei District of Shanghai.
According to Shanghai's health insurance policy, Shanghai's health insurance participants who are hospitalized in foreign hospitals for emergency treatment or emergencies can return to Shanghai to be reimbursed for their medical expenses with the patient's "Hospitalization Expense Detailed Slip," "Charge Receipt," and "Discharge Record," among other materials.
In an interview with the media in early January this year, Ding Xinmin, the defendant and former attending physician at Tianxing Health Center, had said, "This is not a secret, and there is no secret to speak of, everyone knows."
Once the forgery formed **** knowledge, the whole process was open and simple: the participant would provide his basic information to the doctor, who would write a slip, pay the 2,000 yuan invoicing fee at the finance office, and then give the receipt to the doctor, who would then issue a fake medical record to the participant.
The fictitious medical records are mostly for common diseases, such as hypertension and coronary heart disease. Nurses then add the patient's temperature and medication records, and then hand them over to the attending physician for signature, and a medical record is complete. For high blood pressure to buy insurance, I just happened to organize the relevant content, I hope to help you: the latest strategy! High blood pressure people insured full strategy!
In addition, there is also a need for an itemized statement of expenses, which also needs to be made up for hospitalization, medication, oxygen, and examination fees, and then taken to the finance for invoicing.
Once the bills are completed, the participant can take them and return to the Shanghai Medical Insurance Affairs Center for reimbursement. Chen Jinjiang said the process, which operates at Tianxing Health Center, is as smooth as a factory assembly line.
"The reimbursements for these participants are all under 10,000 yuan, and the reimbursements are basically the same." Chen Jinjiang said.
Defendant Chen Qin moved his household registration from Jiangsu to Shanghai in 2004, and his health insurance relationship moved to Shanghai with him, because there are acquaintances in the Tianxing Health Center who used to take his father-in-law to see a doctor and heard from the doctor that he could issue false bills. So Chen Qin found three Shanghai health insurance participants Tao Yulan, Han Qun and Chen Guoliang, to 200 yuan per month to the price of the participant's health insurance card to rent over, their own to the Tianxing Health Center false invoices, each time the payment to the doctor's benefit fee of 2,500 yuan.
With three sets of false health insurance reimbursement vouchers issued by Tianxing Health Center, Chen Qin cheated 21,000 yuan of health insurance reimbursement.
"In this, everyone at every step of the process, is a profiteer, but it seriously jeopardizes the safety of the health insurance fund." Chen Jinjiang told this reporter that the 2,000 yuan invoicing fee received for each set of false cases did not go into the health center's account, but into another account of Li Chenghua.
The prosecutor handling the case had said the doctor could receive 200 yuan in favor fees for each set of bills he wrote. In a media interview earlier this year, a doctor said he was threatened by the director to stay on or be laid off if he didn't do it.
And as early as 2010, the Shanghai Health Insurance Supervision and Inspection Institute has been staring at Tianxing Health Center, and went to the investigation several times, because all the bills are issued by the hospital, so "can not find the problem, and ultimately or in other cases in the investigation, found that some of the participants involved in this case have not been to the local Taixing, only to find a breakthrough. " Chen Jinjiang said.
Chen Jinjiang told the newspaper that with the increase in the number of cases of insurance fraud in other places, the staff of the medical insurance affairs center will be very vigilant if there are several claims from one region at the same time. "Of course, there are also some judgmental indicators, for example, if it's a bill from a health center, the number of beds can't be greater than 100, and it's unlikely that it has CT or MRI equipment."
In 2006 Shanghai Zhabei District police cracked a case of inter-regional family-type fraudulent health insurance payments, and one of the reasons for the suspicion was that the invoice contained a CT test report, and common sense would dictate that a town of only about 30,000 people is unlikely to be very well-equipped with medical equipment in its hospitals. Subsequent field investigations also confirmed that the township health center indeed did not have CT equipment.
And insurance fraud similar to that at Tianxing Health Center is not an isolated case. Li Chenghua said he actually learned his practices from other health centers.
Paul's tips: as the angel of life-saving but chapter our patients' money, it is still in our hearts the white angel? Who stained the white angel's clothes black? Is our health insurance can be a little better?