医保基金违规
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青海曝光5起医保基金违规典型案例
Zhong Guo Xin Wen Wang· 2025-11-16 00:46
Group 1 - Qinghai Province's Medical Insurance Bureau exposed five typical cases of medical insurance fund violations, involving designated pharmacies, medical institutions, and insured individuals, highlighting issues such as drug trafficking, illegal cashing of savings books, and excessive medical treatment [1][2] - The special rectification action initiated by the Qinghai Medical Insurance Bureau this year has maintained a high-pressure regulatory stance, leading to the serious investigation and handling of multiple cases [1] - The drug distribution sector has been particularly problematic, with two pharmacies, Xining Saiyida Pharmacy and Qinghai Fukang Medical Chain Binhua Pharmacy, found guilty of falsifying drug delivery documents and invoices, involving a total of 1,474.2 yuan in illegal funds [1] Group 2 - Medical institutions have shown the most severe violations, with the Lanzhou Hand-Foot Surgery Hospital's Guo De Tibetan Hospital branch being reported for multiple violations including project switching, overcharging, and excessive treatment, involving 280,200 yuan in funds [2] - The Tongren City Nankazang Western Medicine Combined Clinic in Huangnan Prefecture was found to have assisted in impersonating patients, large-scale fraudulent billing, and excessive prescriptions, involving 462,800 yuan in funds [2] - The reported violations have led to the recovery of funds and penalties, with whistleblowers receiving rewards for their reports [2]