对骗保行为“零容忍”！国家医保局首次公布个人欺诈骗保典型案例

Core Insights - The National Healthcare Security Administration (NHSA) of China has announced seven typical cases of individual fraud against the healthcare insurance system, marking the first public disclosure since the initiation of a special rectification campaign for healthcare fund management issues [1][2]. Group 1: Fraud Cases - The seven cases involve various fraudulent activities, including impersonation for medical treatment and the resale of healthcare drugs [1]. - Specific cases include: - A case in Shenzhen where an individual named Li impersonated others to obtain medical services and resold drugs [1]. - A couple in Beijing involved in reselling healthcare drugs [1]. - Individuals in Hubei and Shanghai also implicated in similar drug resale schemes [1]. - A case in Xinjiang involving false invoicing for reimbursement [1]. - A case in Jilin where an individual sought double reimbursement for medical expenses already paid by a third party [1]. - A case in Tianjin involving impersonation for medical treatment [1]. Group 2: Regulatory Measures - Big data screening has played a crucial role in identifying these fraudulent activities, with the Shenzhen healthcare bureau utilizing data models to monitor abnormal prescription behaviors [2]. - The NHSA has emphasized a "zero tolerance" policy towards fraud, indicating that regulatory efforts will be intensified through the use of technology such as drug traceability codes and enhanced inter-departmental collaboration [2].