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]

生育保险基金是国家面向未来的投资，更是事关千万家庭生命延续的民生福利，蚕食这笔资金无疑 是在动摇社会公共利益的根基。 据悉，在国家医疗保障局的推动下，目前全国已有20个省份全面实现了生育津贴直接发放至个人， 对预防企业骗保有着积极作用。但新举措推行过程中，仍面临着海量数据集纳工作和繁重的审核任务， 加快构建智能审核体系迫在眉睫。此外，一些犯罪分子之所以能得逞，利用的是"信息壁垒"制造的"灯 下黑"。这些情况都指向一个现实需求——不断探索技术加持下的精准监督、精细管理。对此，医保部 门、医疗机构、用人单位之间要尽快建立信息共享机制，实现生育保险基金账户的实时监控、智能预 警。只有让骗保行为在系统监控中更加透明、更可追踪，精准打击才可能实现。 生育保险基金是国家面向未来的投资，更是事关千万家庭生命延续的民生福利，蚕食这笔资金无疑 是在动摇社会公共利益的根基。铲除骗保"蛀虫"，铁腕惩治欺诈骗保行为的高压态势还得保持下去，破 解监管难题的精细手段也要升级起来。 来源：检察日报 一家公司两年内近七成员工都在生孩子，如此怪象令人瞠目结舌。一查竟是虚构劳动关系，为已怀 孕但未参加医保的人员代缴医疗保险，骗取生育津贴249万 ...