聚焦生育保险基金，国家医保局曝光5起骗保典型案例
2 1 Shi Ji Jing Ji Bao Dao·2025-10-17 07:37

Core Viewpoint - The National Healthcare Security Administration (NHSA) is intensifying efforts to combat fraud in maternity insurance, highlighting the importance of maintaining the integrity of the maternity insurance fund and protecting the rights of insured individuals [1] Group 1: Fraud Cases - NHSA has exposed five typical cases of fraud involving both insured units and individuals [2] - Three cases involved insured units, including Hebei Province's He Shun Human Resources Co., Heilongjiang Province's Ba Si Te Trading Co., and Guangxi Zhuang Autonomous Region's Feng Da Food Distribution Center [2] - Two cases involved individuals, specifically a man from Liaoning Province and a participant from Shanghai who forged documents to claim maternity insurance funds [2] Group 2: Notable Case - The case involving He Shun Human Resources Co. attracted significant attention, where the company fraudulently claimed maternity benefits amounting to 2.4916 million yuan by fabricating labor relationships [3] - The actual controller and financial personnel of the company were arrested, and the main perpetrator was sentenced to ten years in prison [3] Group 3: Characteristics of Fraud - Recent trends in maternity insurance fraud include common illegal behaviors such as fabricating participant information and labor relationships [4] - There is an increasing trend of criminal accountability for fraud, with more cases being referred to law enforcement for prosecution [4] - The sources of fraud detection have diversified, including complaints, data analysis, and routine inspections [4] Group 4: Regulatory Challenges - Variations in regional policies and execution inconsistencies in maternity insurance management create opportunities for fraud [5][6] - The lack of uniformity in the implementation of maternity insurance policies leads to regulatory loopholes that can be exploited [7] - There is a need for improved awareness of maternity insurance policies among participants and companies to mitigate fraud risks [8]