Doctors who defrauded the health insurance fund were prosecuted for criminal liability. The Municipal Health Insurance Bureau notified ten major cases of fighting fraud and insurance fraud_Suzhou Society_Suzhou News Network

Since the beginning of this year, the city has suspended 172 health insurance services at designated medical institutions, 11 designated agreements have been lifted, and 8 administrative penalties suspended; 686 insured persons have been interviewed, 482 medical insurance card agreements have been suspended and 2 administrative sanctions have been granted; 5 people have been rewarded for reporting 3,700 Yuan, the recovery of fund expenses and fines amounted to nearly 69 million yuan.

Su Baoxun (Weekly Reporter Letter) At the 2020 health insurance fund oversight press conference held yesterday, the Municipal Health Insurance Office notified the city’s top ten cases of fighting fraudulent insurance, and institutions and relevant personnel have been treated in accordance with laws and regulations.

In order to protect people’s “life-saving money”, this year, the Municipal Health Insurance Office insisted on combating fraudulent insurance and creating a long-term monitoring mechanism, jointly carrying out a series of special governance jobs with multiple departments. Since the beginning of this year, the city has suspended 172 health insurance services at designated medical institutions, 11 designated settlements have been lifted, and 8 administrative penalties lifted; 686 insured persons have been interviewed, 482 medical insurance card agreements have been suspended and 2 administrative sanctions have been served; 5 people have been rewarded for reporting 3700 Yuan, the fund’s cost recovery and fines amounted to nearly 69 million yuan.

The four designated medical institutions that were fined this time were the following: Suzhou Meichang Clinic falsified medical services, falsified medical documents and bills, recorded medical expenses that should be borne by people in the field of payment of the health insurance fund, and defrauded the health insurance fund. Due to the large number of people involved and the large amount of money, in order to obtain key evidence, the Municipal Medical Insurance Office transferred the leads to the public safety department for filing and investigation; Suzhou Wuzhong District Shihu West Road Clinic manufactured medical services, falsified medical documents and bills, and defrauded the medical insurance fund for a total of 173,550.57 yuan; The Liya Dental Clinic in Suzhou Wuzhong Economic and Technological Development Zone defrauded the 61,795 yuan health insurance fund for the exchange of diagnosis and treatment projects; the Xinjiang Clinic in Suzhou Wuzhong Economic Development Zone provided credit card accounting services for undesignated medical institutions, defrauding health insurance fund spending of 1,3758.8 yuan.

Suspects involved in the case of fraud of health insurance funds by Suzhou Meichang Clinic are reported to have been approved for arrest. The Municipal Health Insurance Office ordered the other three designated medical institutions to return the fraudulent amount and impose a fine, terminate their fixed-point health insurance contract with them, and revoke the qualifications of the relevant personnel.

The four designated pharmacies that were fined this time are: Zhangjiagang Taihuatang Pharmacy Co., Ltd. exchanged items for the insured staff and defrauded the health insurance fund to spend 140,595.4 yuan; Kunshan Meiluojiahui Pharmaceutical Co., Ltd. provided non-designated medical institutions Credit card accounting services, drug exchange, consumables, items, etc. for the insured, he defrauded the health insurance fund expense of 66,506.30 yuan; Suzhou Hengshuntang Pharmacy Co., Ltd. exchanged medicines, consumables, items, etc. for insured persons, defrauded health insurance fund expense of 41,492.32 yuan; Suzhou Yuxiangtang Pharmacy Co., Ltd. exchanged drugs for the insured staff and defrauded the health insurance fund to spend 2,329.7 yuan.

The Municipal Health Insurance Office ordered the relevant institutions to return the illegal amount and impose a fine and terminate the fixed-point health insurance contract.

The city doctor, Liu Moumou, reportedly arranged for his mother to be hospitalized at the hospital where I worked many times and used Liu Moumou’s health insurance card to pay for medical expenses, defrauding the fund. of health insurance in more than 20,000 yuan. Liu’s husband, Zhang, worked at the same hospital. Zhang arranged for his father-in-law to be hospitalized and used Zhang’s health insurance card to settle medical expenses, defrauding the health insurance fund of 4,841.85 yuan. At present, the Municipal Health Insurance Bureau has transferred Liu to the public security agency for criminal liability and ordered Zhang to return the fraudulent health insurance fund and impose a triple fine. The relevant results have been reported to the municipal health department and the municipal department of disciplinary inspection and supervision.

In another case, Feng used someone else’s health insurance card to obtain health insurance funds by fraudulently using someone else’s health insurance card at the gynecological clinic of the Binjiang Branch of Changshu First Town Hospital. The Changshu Health Insurance Bureau ordered the return of the health insurance fund obtained through fraud and imposed a double fine.