What are the schemes of health insurance fraud

Medicare, or social health insurance, is an important part of social insurance for workers, and it is also the one that workers have the most contact with in their lives. Workers go to the hospital to see a doctor, the state through the medical insurance to give them some support to reduce the pressure of workers. Provide the public with basic medical protection, however, some people use health insurance to fraudulent behavior is also prohibited, and there are a variety of means, so exactly how to determine fraud? The use of health insurance fraud and what sets? I organized the relevant content for your reference.

A, the use of health insurance fraud set

(a) fictitious expenditures, falsified medical records, and even semi-public collective forgery

For example, the blood draw a, although not implemented, but in the cost of the expense column deducted the cost. Anshan City, a hospital former director of Li Mou during his term of office, in the name of "for the hospital to generate income", called on the entire hospital staff together to forge false medical records, hospitalization fees, etc., fraudulent health insurance premiums.

(2) Excessive medical care, induced to see the doctor, the patient, the health insurance "two cheats"

At present, many places appeared specifically for the elderly elderly insurance fraud cases. I learned that some hospitals and clinics are now trying to defraud the insurance industry by tricking the elderly into hospitals in the name of free medical checkups and free clinics, claiming that they have all kinds of health problems, and then prescribing medicines to these elderly people at random, and then using their medical insurance cards to create fictitious medical records to get the medical insurance fund. This approach is covert and difficult to detect and investigate.

(C) hanging bed insurance, almost become the industry "unspoken rules"

Nearly hospitals and patients "joint" in the hospital registration hospitalization, through the empty hanging beds set off health insurance funds.

Two, how to deal with fraudulent behavior

Accelerate the establishment of long-term mechanism of fund supervision, can be applied to the dynamic audit of big data. Employee health insurance supervision is mainly based on the medical service agreement, the lack of legal policy basis, the regulatory authorities found that the hospital "hospitalization", hanging bed insurance fraud, minor illnesses and other violations, only a fine, and the punishment is mainly the suspension of the hospital health insurance payment agreement, due to the low cost of violations, some hospitals repeatedly investigated repeated offenders. Experts suggest that the social security field should be improved in the field of bad faith behavior punishment policy, fraud and insurance to form a strong deterrent, while accelerating the establishment of long-term mechanism for fund supervision, accelerate the legislation of health insurance supervision. For the large number of hospitals and patients, the problem of insufficient power of the regulatory body, experts suggest that big data technology can be used to strengthen dynamic supervision, data warning to do a good job of prevention.