Peninsula All-Media Reporter Zhang Changwei
On December 15, Qingdao Municipal Medical Insurance Bureau and Qingdao Municipal Public Security Bureau Criminal Police Detachment held a press conference to combat fraud in the medical insurance field. Cui Shun, deputy captain of the Second Brigade of the Municipal Public Security Bureau Criminal Police Detachment, introduced the municipal public security organs Work on combating medical insurance fraud.
Since the nationwide special campaign to regulate the use of medical insurance funds was launched this year, in accordance with the specific deployment of the provincial department, the Qingdao Municipal Public Security Bureau has attached great importance to it and actively carried out various tasks. 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 collaboration with the Municipal Medical Insurance Bureau, Municipal Health and Health Commission and other departments, maintain zero tolerance for illegal and criminal activities of fraud and insurance fraud in the city, and fight hard Attack and crack down severely in accordance with the law. Since
launched the special operation, it has eliminated 3 criminal gangs, arrested 35 suspects, uncovered 207 cases of medical insurance fund fraud, involving a total value of more than 27 million yuan, recovered more than 8 million yuan of stolen money, eliminated 2 medical institutions involved in the case, and assisted in insurance fraud. There are 13 intermediaries. 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 through work The company 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 the Shibei Public Security Bureau, the Municipal Medical Insurance Bureau and other departments, set up a task force to launch the investigation. After investigation, it was found that the hospital implemented an organized "one-stop" medical insurance fraud model headed by the hospital's legal representative Teng. It defrauded the national medical insurance fund by forging medical records and performing false hospitalizations. The amount involved was as high as 10 million yuan. After investigation and evidence collection, The task force organized a centralized network and arrested a total of 16 suspects including the company's legal representative Teng and the business director Li. Currently, a total of more than 4 million yuan in stolen money has been recovered.
(2) Uncovering the medical insurance fund fraud case of Renai Hospital in Licang District under the cover of a nursing home
The Criminal Police Detachment of the Municipal Bureau, together with the Qingdao Municipal Medical Insurance Bureau, Licang Branch and other departments, broadened the scope of investigation and discovered Renai Hospital in Licang District through work There was a case of using 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 opened for investigation of Licang Renai Hospital. A total of 2 suspects were arrested in this case. name, and recovered more than 110,000 yuan in losses from the medical insurance fund.
(3) The first case of maternity insurance subsidy fraud in the province was cracked - the "8.9" fraud case
This case was jointly investigated by the Criminal Police Detachment in conjunction with the Municipal Medical Insurance Bureau and the Development Zone Branch. It is the first case in Shandong that has been solved since the implementation of the new maternity insurance subsidy policy in 2020. The first case of maternity insurance subsidy fraud. 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.
In recent years, cases of fraud on medical insurance funds have been on the rise across the country. Criminal medical insurance fraud has seriously disrupted the order of national medical security and directly touched on people's livelihood issues concerning the vital interests of the people. Since the Ministry of Public Security and the Provincial Department of Public Security deployed a special rectification campaign to crack down on insurance fraud, the Qingdao Municipal Bureau has taken it as a step to strictly crack down on criminal activities of defrauding medical insurance funds and protecting the people's "medical treatment money" and "life-saving money" to maintain security in the field of people's livelihood. We must always maintain a high-pressure attitude towards major events. I hereby solemnly warn those who use unfair means to illegally obtain medical insurance funds to take the initiative to explain the situation to the public security organs as soon as possible, hand over illegal and illegal gains, and strive for leniency.We will severely crack down on those who are unrepentant, unrelenting, and continue to defraud the national medical insurance fund in accordance with the law to safeguard the national medical security system and effectively protect people's livelihood.
Attached: Qingdao’s reporting hotline for combating fraud in the medical insurance field
Designated hospitals in the three districts of the city: 0532-85751052
Designated communities, nursing institutions and designated pharmacies under the jurisdiction of Shinan District: 0532-85971819
Designated communities under the jurisdiction of Shibei District, Nursing institutions and designated pharmacies: 0532-83625130
Designated communities, nursing institutions and designated pharmacies under the jurisdiction of Licang District: 0532-84650830
Laoshan District: 0532-88996881
Chengyang District: 0532-58659929
West Coast New District: 0532-86131866
Jimo District: 0532- 88539902
Jiaozhou City: 0532-82289168
Pingdu City: 0532-87367812
Laixi City: 0532-83969957
