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空挂床、虚增药品进价……最高法严惩医保骗保
第一财经·2025-08-05 03:51

Core Viewpoint - Private hospitals play a significant role in enhancing medical resources and drug procurement, but some have engaged in fraudulent activities to defraud medical insurance funds, leading to legal consequences [3][5]. Group 1: Fraud Cases and Legal Actions - The Supreme People's Court reported on August 5, 2024, detailing severe punishments for medical insurance fraud, highlighting four typical cases of such crimes [3][5]. - A notable case involved a private hospital in Shanxi, where the accused inflated drug prices, duplicated drug entries, and fabricated medical records to defraud over 9.7 million yuan (approximately 1.5 million USD) from the medical insurance fund [4][5]. - The court sentenced the main perpetrator to 13 years and 6 months in prison, with fines imposed on several accomplices, reflecting the judiciary's strict stance against such fraudulent activities [4][5]. Group 2: Impact on Medical Insurance System - The Supreme Court emphasized that while private hospitals contribute to medical service provision, fraudulent practices undermine the integrity of the medical insurance system, necessitating strict legal action [5]. - In 2024, courts across the country concluded 1,156 cases of medical insurance fraud involving 2,299 individuals, marking a 131.2% increase in case resolution compared to the previous year, and recovering over 400 million yuan (approximately 56 million USD) in defrauded funds [5].