医保基金如何成“生意”？揭秘医保骗保“黑色产业链”

Core Points - The article discusses a significant case of medical insurance fraud in Shanxi Province, where a hospital was involved in fraudulent activities to exploit the national medical insurance fund [1][9] - The case highlights various methods used by the defendants to inflate hospital admissions and costs, ultimately leading to substantial financial gains at the expense of the insurance system [5][7] Summary by Categories Fraud Methods - Method 1: Increasing Fake Inpatients The hospital recruited patients through incentives, paying referral fees to those who brought in new patients, thereby artificially inflating the number of hospital admissions [2][3] - Method 2: Phantom Admissions Some patients did not actually stay in the hospital but left their insurance cards there, allowing the hospital to create false medical records and claim reimbursements [3][4] - Method 3: Inflating Treatment Costs The hospital exaggerated the treatment costs for patients, even those with minor ailments, to reach the maximum reimbursement limits set by the insurance [5][6] - Method 4: Financial Manipulation The hospital submitted inflated drug costs to the insurance fund, with discrepancies between actual drug purchase prices and reported amounts, leading to significant overclaims [7][8] Legal Consequences - The main defendant, identified as Ai, was sentenced to 13 years and 6 months in prison, along with fines, while other co-defendants received varying sentences [9]