骗取医保基金
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超量购药、倒卖牟利 5起个人骗取医保基金典型案例公布
Yang Shi Wang· 2025-11-05 12:50
Core Viewpoint - The National Medical Insurance Administration has reported five typical cases of individuals fraudulently obtaining medical insurance funds, highlighting serious issues of excessive drug purchases and collusion with "drug dealers" that undermine the integrity of the medical insurance system [1] Group 1: Case Summaries - Case 1: A resident of Lijiang, Yunnan, named Luo, fraudulently purchased and resold medications, causing a loss of 2.199 million yuan to the medical insurance fund from March 2021 to August 2023 [2] - Case 2: In Chongqing, two individuals, Song A and Song B, exploited their special disease insurance to excessively purchase and resell medications, resulting in a loss of 627,300 yuan since January 2023 [3] - Case 3: Zhang from Meishan, Sichuan, was found to have made excessive purchases across multiple medical institutions, leading to the dismantling of a large criminal gang and a recovery of 269,700 yuan for the medical insurance fund [4] - Case 4: Xu from Leqing, Zhejiang, was involved in fraudulent activities since 2016, leading to a loss of over 170,000 yuan, and was sentenced to three years in prison with a suspended sentence [5] - Case 5: Liu and three others in Ganzhou, Jiangxi, were found to have excessively purchased a specific medication, resulting in a loss of over 20,000 yuan, with ongoing investigations into the involved medical personnel [6][7] Group 2: Regulatory Actions - The National Medical Insurance Administration, in collaboration with judicial authorities, has taken strict actions against individuals involved in fraudulent activities, including criminal prosecutions and financial recoveries [1][7] - The cases reveal significant issues related to excessive drug purchases and the involvement of medical personnel, prompting the administration to adopt a "zero tolerance" policy towards fraud [7]