What are the routines for medical insurance fraud?

Medical insurance, that is, social medical insurance, is an important part of workers' social insurance, and it is also the most contacted by workers in their lives. Workers go to the hospital to see a doctor, and the state gives some assistance through medical insurance to reduce the pressure on workers. It provides basic medical insurance for the public, but some people use medical insurance to cheat insurance, and there are various means, so how to judge cheating insurance? What are the routines for using medical insurance to cheat insurance? I have sorted out the relevant contents for your reference.

First, the use of medical insurance fraud routines

(1) fabricated expenses, forged medical records, and even semi-publicly fabricated collectively.

For example, no blood drawing was carried out, but the expenses were deducted in the expense column. During his tenure, Li, the former president of a hospital in Anshan, called on the staff of the whole hospital to falsify medical records and hospitalization expenses in the name of "generating income for the hospital" to defraud medical insurance.

(2) Excessive medical treatment and induced medical treatment, patients and medical insurance "cheat at both ends"

At present, there are many cases of fraudulent insurance for the elderly. I understand that some hospitals and clinics now trick some elderly people into hospitals in the name of free physical examination and free clinic, claiming that they have various physical problems, and then prescribe some medicines to these elderly people at will, and then use their medical insurance cards to supplement their medical records and withdraw medical insurance funds. This method is very hidden and difficult to find and investigate.

(3) Hanging the bed to cheat insurance has almost become the "hidden rule" of the industry.

Nearby hospitals and patients "jointly" registered in the hospital and obtained medical insurance funds through empty beds.

Second, how to deal with insurance fraud

Accelerate the establishment of a long-term mechanism for fund supervision and apply dynamic review of big data. The supervision of employees' medical insurance is mainly based on medical service agreement, which lacks legal and policy basis. When the regulatory authorities find that the hospital "invites people to stay in the hospital", cheats on the bed, treats minor illnesses and other irregularities, they can only be punished once, and the punishment content is mainly to suspend the hospital medical insurance payment agreement. Due to the low cost of violation, some hospitals repeatedly investigate and commit crimes. Experts suggest that we should improve the disciplinary policy of dishonesty in the social security field to form a powerful shock to fraudulent insurance, and at the same time accelerate the establishment of a long-term mechanism for fund supervision and accelerate the legislation of medical insurance supervision. In view of the large number of hospitals and patients and the insufficient strength of regulatory agencies, experts suggest that big data technology can be used to strengthen dynamic supervision and prevent data early warning.