医疗保障是事关人民群众健康福祉的重大民生工程,涉及千家万户,维护医保基金安全是全社会的共同责任。近年来,打击欺诈骗保专项行动不断深入,通过典型案例的查处,对违法违规人员形成了有效震慑。然而,欺诈骗取医保基金犯罪仍未从根本上得到遏制,尤其是在交通事故等外伤医治中欺诈骗保行为呈现易发趋势。分析欺诈骗保犯罪行为的发生原因,针对性地提出系统性预防方案,对维护医保基金安全有序运行有重要的现实意义。

Healthcare security is a major livelihood project that concerns the health and well-being of the people, involving thousands of households. Maintaining the safety of healthcare security funds is responsibility of the whole society. In recent years, the special action against insurance fraud has been continuously implemented, and has effectively deterred illegal and irregular personnel with the investigation and punishment of typical cases. However, the crime of fraudulently obtaining healthcare security funds has not been fundamentally curbed, especially in the treatment of injuries in traffic accidents, where medical insurance fraud is prone to occur. Analyzing the causes of medical insurance fraud and proposing targeted and systematic prevention plans is of great significance for maintaining the safe operation of medical insurance funds.