Analysis of Characteristics of Medical Insurance Fraud Behavior and Research on the Agile Prevention and Governance Strategies

doi:10.19546/j.issn.1674-3830.2024.12.006

China Health Insurance ›› 2024, Vol. 0 ›› Issue (12) : 33-39. DOI: 10.19546/j.issn.1674-3830.2024.12.006

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Abstract

With the increasing efforts to crack down on medical insurance fraud in the medical insurance field, the behavior of medical insurance fraud presents characteristics such as diverse implementation subjects, various professional methods, hidden and complex behaviors, and increased social harm, resulting in the increased difficulty of regulating medical insurance fund. There are many problems, such as difficulties in evidence collection and investigation, difficulties in recovering stolen goods and losses, and difficulties in cracking down on complex entities in multiple links. In order to solve the problems and further maintain the medical insurance fund security, this paper starts with the agile prevention and governance theory with multi-agent collaborative governance and risk prevention as the core, constructs a multi-subject collaborative prevention and governance model, to promote the sustainable and stable operation of the medical insurance fund.

Key words

medical insurance fraud / situational prevention / agile prevention / collaborative governance

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Analysis of Characteristics of Medical Insurance Fraud Behavior and Research on the Agile Prevention and Governance Strategies[J]. China Health Insurance. 2024, 0(12): 33-39 https://doi.org/10.19546/j.issn.1674-3830.2024.12.006

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