National Medical Insurance Administration: from 2018 to October 2021, about 50.6 billion yuan of medical insurance fund was recovered
2021-12-09
Today, the national medical insurance bureau held a media briefing on "strengthening the connection of execution and cracking down on fraud and insurance fraud", introducing the relevant information of the national medical insurance bureau and the Ministry of public security on strengthening the connection of execution in investigating and dealing with cases of swindling medical insurance funds. Medical insurance fund is the "life insurance money" and "medical treatment money" of the people. The safety of the fund involves the vital interests of the people. According to the relevant person in charge of the National Medical Insurance Bureau, from 2018 to October 2021, about 2.34 million designated medical institutions were inspected, about 1 million were handled, and about 50.6 billion yuan of medical insurance fund was recovered. The official said that since the launch of the special rectification action against fraud and insurance fraud this year, the National Medical Insurance Bureau, together with the Ministry of public security, the National Health Commission and other departments, has made heavy and accurate attacks, cooperated closely and coordinated linkage. By the end of October, the national medical insurance department had investigated and dealt with 3970 cases involving "three false" cases, suspended 142 medical insurance service agreements, terminated 61 medical insurance service agreements 196 participants' online settlement of medical expenses was suspended, 536 (persons) were transferred to public security and judicial organs and 76 (persons) were transferred to discipline inspection and supervision organs, and a total of 140 million yuan of medical insurance related funds were recovered. The main contents include: First, establish a departmental consultation mechanism and strengthen departmental linkage. The national medical insurance bureau and the Ministry of public security regularly hold coordination meetings to combat fraud and insurance fraud, inform the development of the fight against fraud and insurance fraud, analyze the situation and tasks of combating the illegal and criminal activities of defrauding medical insurance funds, coordinate and solve the problems existing in the work, study and put forward measures to strengthen prevention and investigation, and continuously and deeply promote the special rectification work. Second, establish a joint Listing Supervision Mechanism and strengthen the investigation and handling of major and important cases. The national medical insurance bureau and the Ministry of public security have established a dispatch notification mechanism and a case listing and supervision system to strengthen the punishment of illegal and criminal acts of defrauding medical insurance funds. At present, 22 major cases of defrauding medical insurance funds have been listed and supervised. Third, establish a daily cooperation mechanism and strengthen the joint force of comprehensive supervision. Guide medical insurance departments at all levels to strengthen cooperation with public security organs and health departments and promote comprehensive supervision. For example, the medical insurance Department of Hebei Province, together with the public security organ and the health department, has jointly carried out on-site inspection, unannounced visits and verification, realizing the "Qi Li Fei inspection" of the medical insurance, public security and health departments; Guangxi's medical insurance department strengthened the connection and contact with the public security department, formed a consultation mechanism, joint investigation mechanism and case transfer mechanism, carried out 41 joint inspections and transferred 46 case clues, which effectively deterred medical insurance violations; Chongqing Medical Insurance and public security departments focused on key regulatory areas such as outpatient chronic diseases, realized "key crackdown" on fraud and insurance fraud, and strengthened the deterrent effect of medical insurance regulation. Fourth, establish a typical case exposure mechanism and strengthen warning publicity. Open an exposure column on the official website of the National Medical Insurance Bureau, supervise and guide all localities to establish and improve the case exposure mechanism, and strengthen the warning publicity of combating fraud and insurance fraud. By the end of October, the national medical insurance bureau had exposed 49 cases in five phases, involving 108 million yuan of illegal funds; Local medical insurance departments at all levels exposed 18000 cases of violations of laws and regulations, and cashed in about 874000 yuan of reward for reporting. On October 8, the Ministry of public security and the medical insurance bureau jointly held a press conference on the special rectification of medical insurance fraud and insurance fraud, informing the typical cases of medical insurance fraud and insurance fraud, phased progress and next work objectives, publicizing the policy of combating medical insurance fraud and insurance fraud to the broad masses of the people, and creating a good regulatory environment of "everyone knows the law and everyone abides by the law". Fifth, establish an information sharing mechanism and strengthen big data supervision. The national medical insurance bureau and the Ministry of public security have strengthened the application of big data means in the supervision of medical insurance funds. At present, six cities have been selected to carry out pilot work to explore and build a fund supervision mechanism of "early discovery and small attack". All localities have also made good exploration. Chongqing Medical Insurance Bureau has cooperated with the public security bureau to effectively connect the execution, and successfully cracked the major case of two companies swindling medical insurance funds through big data investigation; Changsha Medical Insurance Bureau of Hunan Province and the public security department jointly established a special class for medical insurance anti fraud, gave play to the advantages of information supervision, successfully locked in a number of illegal facts and corresponding evidence of cases, and realized the "accurate blow" of medical insurance fund supervision. It is reported that in order to further deepen the special rectification work on the fraud of basic medical insurance, the end time of the special rectification action will be extended from the end of December 2021 to the end of December 2022, further focus on the key areas of medical insurance supervision, and constantly improve the breadth and depth of the special rectification action. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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