On December 15, the Qingdao Municipal Government Information Office held a press conference to introduce the work on combating fraud in the field of medical insurance. Among them, three typical cases of defrauding medical insurance funds were reported.
Cui Shun, deputy captain of the Second Brigade of the Criminal Police Detachment of the Qingdao Municipal Public Security Bureau, introduced the Qingdao Municipal Public Security Bureau’s work in combating medical insurance fraud. Since the launch of a nationwide special campaign to regulate the use of medical insurance funds this year, the Qingdao Municipal Public Security Bureau has attached great importance to it and actively carried out various tasks in accordance with the specific deployment of the provincial department. Establish a special work team led by the Criminal Police Detachment, with the participation of relevant police types and branches and municipal bureaus, strengthen docking and cooperation with Qingdao Municipal Medical Insurance Bureau, Municipal Health Commission and other departments, maintain zero tolerance for illegal and criminal activities of insurance fraud and fraud in the city, and focus on Strike out with fists and crack down severely in accordance with the law.
According to reports, since the launch of the special operation, 3 criminal gangs have been eliminated, 35 suspects have been arrested, 207 cases of medical insurance fund fraud have been uncovered, with a total value of more than 27 million yuan involved, more than 8 million yuan of stolen money has been recovered, and 2 medical institutions involved have been eliminated. Assistance There are 13 intermediaries that cheat insurance. Typical cases include:
(1) The province’s first organized fraud case of medical insurance fund fraud was uncovered - the “5.14” medical insurance fraud case
In August 2020, Qingdao Municipal Medical Insurance Bureau discovered Qingdao Hengbo Cardiovascular and Cerebrovascular Hospital Co., Ltd. through work He was suspected of defrauding medical insurance funds and handed over clues to the public security organs. After receiving the report, the Criminal Police Detachment attached great importance to it, and together with Qingdao Municipal Public Security Bureau Shibei Branch, Municipal Medical Insurance Bureau and other departments, set up a task force to carry out investigation. After investigation, it was found that the hospital implemented an organized "one-stop" medical insurance fraud model by a group headed by hospital legal person Teng. It defrauded the national medical insurance fund by forging medical records, performing false hospitalizations, etc. The amount involved was as high as 10 million yuan. After investigation and evidence collection, the special case The organization gathered together to close the network and arrested a total of 16 suspects including the company legal person Teng and the business director Li. Currently, a total of more than 4 million yuan in stolen money has been recovered.
(2) Uncovering the case of fraudulent medical insurance funds at Renai Hospital in Licang District under the cover of a nursing home.
The Criminal Police Detachment of the Qingdao Municipal Public Security Bureau, together with the Qingdao Municipal Medical Insurance Bureau, Licang Branch and other departments, expanded the scope of investigation. After work, it was discovered that Licang District Ren'ai Hospital used the internal Qingdao Jiujiu Sunset Red Nursing Home and its employees to inflate inpatient treatment and medical expenses. It was suspected of medical insurance fund fraud, so a case was launched against Licang Ren'ai Hospital and a total of criminal suspects were arrested in the case. Two people were involved, and the loss of the medical insurance fund was restored to more than 110,000 yuan.
(3) The first case of maternity insurance subsidy fraud in the province - the "8.9" fraud case
was cracked The first case of maternity insurance subsidy fraud in Shandong uncovered since. After work, it was found that the criminal suspect Wang, in order to obtain illegal benefits, conspired with the criminal suspects Che and Zhang to defraud urban employees' maternity insurance by fictitious labor relations to apply for high maternity allowances for unqualified mothers. , and agree on the proportion of the spoils. From April 2020 to September 2021, Wang successively provided 302 pregnant women who did not meet the insurance conditions with 13 companies including Qingdao Zhongjing Yunchuang Enterprise Management Consulting Co., Ltd. and Qingdao Jingwu Zhijing Automobile Service Co., Ltd. In the name of Qingdao City, he paid employee medical insurance to the Shibei District and Huangdao District Medical Insurance Centers and defrauded maternity allowances. The case was committed with new methods, many people were involved, and the amount of money involved was huge. A total of 17 suspects have been arrested so far, and more than 4 million yuan in stolen money has been recovered.
(reported by Dazhong Daily client reporter Bo Keguo)
