医保“救命钱”决不能变成“唐僧肉”

Core Insights - The article highlights the issue of fraudulent activities within medical institutions, where staff are found to be falsifying prescriptions and overcharging for services to illegally extract funds from the national medical insurance system [1][2] - In 2024, there was a significant increase in the number of concluded medical insurance fraud cases, with 1,156 cases resulting in 2,299 convictions, marking a year-on-year growth of 130% [1] - The fraudulent practices not only threaten the sustainability of the medical insurance fund but also distort its original purpose of providing basic health coverage [1] Group 1 - The article reports on various medical institutions, including clinics and pharmacies, engaging in deceptive practices to exploit the national medical insurance fund [1] - A specific case in Shanghai involved collusion between hospital management, doctors, and "scalpers," resulting in over 50,000 fraudulent claims and more than 12 million yuan in funds misappropriated over two years [2] - The article emphasizes the need for stricter penalties and enhanced regulatory measures to combat these fraudulent activities, including real-time monitoring of settlement data using big data technology [2] Group 2 - The article stresses the importance of ensuring that every penny of the medical insurance fund is used effectively for health protection, highlighting the need to safeguard these funds as they are crucial for public health [3] - It calls for innovative approaches to enhance the efficiency of fund usage, such as promoting family mutual aid and exploring connections with long-term care insurance [2]