国家医保局公布7起个人骗取医保基金典型案例

Core Viewpoint - The National Healthcare Security Administration (NHSA) is intensifying efforts to combat healthcare fraud, emphasizing the importance of safeguarding the medical insurance fund, which is crucial for public welfare and the sustainability of the healthcare system [1][8]. Summary by Cases Case 1: Shenzhen Fraud - A resident in Shenzhen, identified as Li, exploited others' medical insurance accounts to sell drugs illegally, defrauding the healthcare fund of 93,013.68 yuan. The accomplice, Wang, purchased these drugs for 169,025.00 yuan. Both were criminally detained, and Li was sentenced to 2 years and 4 months in prison [1]. Case 2: Beijing Drug Trafficking - A couple in Beijing, Yu and Wang, were caught selling healthcare drugs at a lower price after acquiring them from elderly individuals. The total value of the drugs involved exceeded 110,000 yuan. They received sentences of 1 year and 2 months, with a suspended sentence and a fine of 20,000 yuan [2]. Case 3: Hubei Abuse of Benefits - In Hubei, two individuals, Qiu and Ke, misused their outpatient chronic disease benefits to sell drugs, resulting in a total fraud amount of 408,25.78 yuan. Qiu was sentenced to 3 years and 9 months, while Ke received a 2-year sentence [3]. Case 4: Shanghai Resale of Drugs - A 74-year-old retiree in Shanghai, identified as Hu, was found reselling drugs purchased through the healthcare system. The NHSA recovered 5,223.31 yuan in funds and imposed a fine of 13,320.00 yuan [4]. Case 5: Xinjiang False Claims - A retiree in Xinjiang, identified as Tan, submitted fraudulent medical bills over 27 instances, defrauding the healthcare fund of 426,218.45 yuan. He was sentenced to 3 years in prison with a 4-year suspension and fined 50,000 yuan [5]. Case 6: Jilin Duplicate Claims - In Jilin, an individual named Gao attempted to claim reimbursement for medical expenses already covered by a third party, fraudulently obtaining 27,394.69 yuan. The case has been forwarded to law enforcement for further investigation [6]. Case 7: Tianjin Identity Fraud - In Tianjin, Zhang was found using another person's medical insurance card for medical services, defrauding the fund of 11,284.99 yuan. She was ordered to repay the amount and fined 22,569.98 yuan [7]. Regulatory Response - The NHSA is committed to enhancing regulatory measures and utilizing technology to track drug sales, aiming for a zero-tolerance policy against fraud. Citizens are encouraged to report any suspicious activities to protect the integrity of the healthcare fund [8].