Wuhan tongji hospital was severely punished for insurance fraud. The modus operandi is simple and rude. How were they discovered?

Tongji hospital, affiliated to Tongji Medical College of Wuhan Huazhong University of Science and Technology, was severely fined 57 million yuan for hospital insurance fraud. His modus operandi was not brilliant, even simple and rude. He was found because someone reported and provided clues, and the relevant departments organized inspections and found it.

On April 20th, the National Medical Insurance Bureau issued a circular on the special flight inspection of the hospital, saying that after receiving the prompt in March, the Medical Insurance Bureau, together with National Health Commission and the General Administration of Market Supervision, knew that Hubei Medical Insurance Bureau and Wuhan Medical Insurance Bureau had conducted surprise inspections on the hospital and found out a big problem.

From 20 17 to 1 to September 2022, tongji hospital falsely reported the problem of high-value medical consumables in orthopedics and defrauded medical insurance payment of more than 23.34 million yuan. He violated the Social Insurance Law of People's Republic of China (PRC) and the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds, and was punished by Wuhan Medical Insurance Bureau.

First of all, he voluntarily returned to the hospital to defraud the medical insurance fund 1.9 1.5 million yuan, and was fined twice. The amount of fraud found in the inspection was 4 1.8 million yuan, which was returned and fined 5 times. . Then the use of the medical security fund for orthopedics in this hospital was suspended for 8 months. In addition, it is found that the medical insurance amount of 202 1 in this hospital is about 910.07 million yuan, which is also suspected of illegal use and is still under verification.

Tongji hospital is a well-known large-scale comprehensive third-class first-class hospital in China. After Tongji was exposed to this insurance fraud case, everyone was very shocked. Because this can be Tongji, such a big hospital has such a problem, so will other hospitals have similar problems? Consumables were given to the patient 200 yuan, but the bill of payment stated the price of 600 yuan, which made the patient think it was a good material.

At first, the hospital was a place to save lives, not a place to make money. Now the doctor-patient relationship is very tense, but this problem undoubtedly adds a big crack to the people's trust in the hospital. It is hoped that the relevant state departments will strictly investigate major hospitals to prevent medical insurance from becoming a fund that benefits some medical institutions. I also hope that the state will strictly investigate the opaque payment system of hospitals.