Since its establishment, the National Healthcare Security Administration has continued to consolidate the tough stance on cracking down on medical insurance fraud. However, according to the cases exposed by the provincial healthcare security administrations, defrauding medical insurance funds by concealing the third-party responsibility is still a field where fraud is common among the insured. This paper takes the typical cases exposed by the medical insurance departments to discuss the problems of the insured concealing the third party responsibility to defraud the medical insurance fund and puts forward suggestions for improvement.
Key words
concealing third-party responsibility /
defraud /
medical insurance funds /
improvement suggestions
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References
[1] 徐冠军,蔡呈曦.医保违规案件处理的现状与对策建议[J].中国医疗保险,2020(10):30-34.
[2] 谢开林. 浅议虚构死亡人员信息骗取医保基金问题及对策[J].中国医疗保险,2022(10):84-86.
[3] 中国保险行业协会.关于发布《中国保险行业协会机动车商业保险示范条款(2020版)》等五个商业车险示范条款的通知[EB/OL].(2020-09-04)[2024-09-05].https://www.iachina.cn/art/2020/9/4/art_24_104621.html.
[4] 中国平安财产保险股份有限公司.平安短期意外伤害保险(互联网版)[EB/OL].[2024-09-05].https://baoxian.pingan.com/pa18shopnst/nstShop/index.html#/productInfo/ZP020326?WT.mc_id=T00-BDPP-24-dqyw.
[5] 中华联合财产保险股份有限公司.住院医疗费用补偿保险(互联网专属)条款[EB/OL].[2024-09-05].https://cxcx.iachina.cn/pages/iacpcprodinfo/ViewContext.jsp?filename=a0c46540-eaf6-44e9-a98d-1ab74a272409.html&productId=16626d6f-a990-454d-ada5-47047ecde81a&productNo=C00001232512024082215543&flag=tiaokuan.
[6] 长安责任保险股份有限公司.长安个人意外伤害保险条款(2014版)[EB/OL].[2024-09-05].https://www.capli.com.cn/pdfyd?file=/u/cms/www/202012/bae75010f8f949148670d42383cebfc6.pdf.
[7] 李丽,吴颖英.湖南省基本医保参保人员意外伤害医疗费用支付的思考[J].江苏卫生事业管理,2024(5):704-707.
[8] 中国政府采购网.浙江省永康市通过政府购买服务推进政保合作防范医保基金风险[EB/OL].(2023-10-10)[2024-09-05].http://www.rencheng.gov.cn/art/2024/3/13/art_106565_2788666.html.
[9] 西安市长安区人民检察院.大数据模型帮助追回了违规报销的医疗费[EB/OL].(2023-07-31)[2024-09-05].http://www.sn.jcy.gov.cn/xasjcy/jcxw/xjdt/202307/t20230731_348889.html.
[10] 隐瞒事实报销又打官司索赔,监督！浙江宁海:借助大数据开展类案监督堵塞医保基金监管漏洞[EB/OL].(2022-06-07)[2024-09-05].https://newspaper.jcrb.com/2022/20220607/20220607_002/20220607_002_1.htm.
[11] 检察日报.浙江绍兴上虞区:检察建议督促堵塞医保基金预先支付漏洞[EB/OL].(2021-10-15)[2024-09-05].https://www.hi.jcy.gov.cn/webSite/module/M101/view/754627/00500008.
[12] 齐永昌. 基层医疗机构基金监管模式的探索与思考——以枞阳县监管实践为例[J].中国医疗保险,2022(4):59-62.
