The National Medical Insurance Bureau exposed 9 cases of fraud and insurance fraud. What are the specific circumstances?

On February 24, the National Medical Insurance Administration exposed the first batch of ***9 typical cases of insurance fraud in 2021 on its official website, including the "Insurance Fraud Case of Jinjing Hospital, Jinzhou City, Liaoning Province" , "Fraud and insurance fraud case of Chunwang Hospital in Wangchengpo, Changsha City, Hunan Province", "Insurance fraud and insurance fraud case of Zhu Moumou, Lianyungang City, Jiangsu Province", etc. The details are as follows:

1. Jinjing, Jinzhou City, Liaoning Province Hospital fraud and insurance fraud case

After a joint investigation by the Jinzhou Municipal Medical Insurance Bureau and the Public Security Bureau, it was found that Huang Moumou, the director of Jinjing Hospital, together with many people inside and outside the hospital, borrowed the medical insurance cards of employees, residents, and students in Jinjing Hospital. The medical insurance system defrauded the medical insurance fund of 290,683.15 yuan by swiping the card for false hospitalization. All illegal funds of 290,683.15 yuan in this case were recovered and returned to the medical insurance center fund account.

The verdict of the local court is as follows: The defendant Huang Moumou, the director of Jinjing Hospital, was convicted of fraud and was sentenced to 8 years and 8 months in prison and fined RMB 500,000; the defendant Tian XX, a legal person of Jinjing Hospital, committed fraud and was sentenced to 9 years in prison and fined RMB 500,000; the defendant Xu XX, a doctor in Jinjing Hospital, was sentenced to 7 years and 3 months in prison for fraud. and a fine of RMB 300,000;

The defendant Duan Moumou, a financial staff member of Jinjing Hospital, committed fraud and was sentenced to 5 years and 6 months in prison and fined RMB 250,000; the defendant Yang Moumou, an employee of Jinzhou Jiutai Pharmaceutical Co., Ltd., committed the crime of fraud and was sentenced to 4 years in prison and fined RMB 150,000; the defendant Han Moumou, a teacher at Liaoning Petrochemical Vocational and Technical College, committed the crime of fraud and was sentenced to He was sentenced to three years in prison, suspended for three years, and fined RMB 50,000.

2. Fraud and insurance fraud at Wangchengpo Chunwang Hospital, Changsha City, Hunan Province

After investigation by the Changsha Municipal Public Security Bureau and the Medical Insurance Bureau, it was discovered that the deputy director of Wangchengpo Chunwang Hospital, Changsha City Li Moumou, president and legal person Liu Moumou and others have defrauded the medical insurance fund of a total of RMB 4,253,947.38 in terms of drugs, laboratory examinations, and traditional Chinese medicine package treatments. The persons involved in the case, Li Moumou and Zhu Moumou, have returned illegal gains of RMB 2 million and RMB 100,000 to the Changsha Medical Security Affairs Center respectively, and the remaining illegal funds of RMB 21,539,47.38 have also been returned to the Changsha Medical Security Affairs Center.

The court ruled as follows: Liu and Li defrauded the national medical insurance fund in extremely huge amounts. Their actions constituted the crime of fraud. Liu was sentenced to 10 years in prison and fined RMB. 100,000 yuan; Li Moumou was sentenced to 3 years in prison, suspended for 5 years, and fined 70,000 yuan.

3. Insurance fraud case at Heshuo Silk Road Yikang Traditional Chinese Medicine Hospital in Heshuo County, Bayingolin Mongolian Autonomous Prefecture, Xinjiang Uygur Autonomous Region

Medical insurance in Heshuo County, Bayingolin Mongolian Autonomous Prefecture The bureau launched an investigation based on the reported clues and found that Yang Moumou, the legal person of Heshuo Silk Road Yikang Traditional Chinese Medicine Hospital, had falsified medical records, lowered hospitalization standards, fabricated expenses, abused antibiotics and other illegal facts, and was suspected of illegally using medical insurance amount of 104,400 yuan. After the case was handed over to the public security, the person involved in the case, Yang Moumou, was criminally detained by the public security on suspicion of fraud. All illegal gains were recovered and returned to the fund account of the medical insurance center.

The verdict of the local court is as follows: The defendant, Yang Moumou, a legal person of Heshuo Silk Road Yikang Traditional Chinese Medicine Hospital, committed fraud and was sentenced to three years in prison, suspended for five years, and fined RMB 100,000.

4. The insurance fraud case involving Zeng at the Central Health Center of Qiliping Town, Hong'an County, Huanggang City, Hubei Province

After a joint investigation by the Hong'an County Medical Insurance Bureau and the Public Security Bureau, it was discovered that Qili The fact that Zeng, an employee of Guoyitang (Rehabilitation Treatment Department) of Pingzhen Central Health Center, defrauded medical insurance funds by forging medical records from August 1, 2018 to May 25, 2019, and the illegally obtained funds in this case were recovered And return it to the fund account of the medical insurance center.

The court ruled that the defendant Zeng was guilty of fraud, and the amount of fraud was 264,927.12 yuan. He was sentenced to three years and six months in prison and fined RMB 100,000.

5. The corruption case of Nian, the former medical insurance administrator and pharmacy charger of Liujiaying Township Health Center, Fengrun District, Tangshan City, Hebei Province

After investigation by the Medical Insurance Bureau of Fengrun District, Tangshan City, Liujiaying Nian Moumou, the medical insurance administrator and pharmacy charger at the township health center, was suspected of defrauding medical insurance funds by falsely reporting hospitalization information in 2018. After the case was handed over to the public security department, the public security department further investigated and fixed the relevant evidence, determined the above illegal facts, and recovered 44,884.65 yuan of illegally obtained funds.

The local court’s verdict was as follows: The defendant Nian was sentenced to seven months’ imprisonment, suspended for one year, and fined RMB 100,000 for being suspected of corruption.

6. Insurance fraud case involving Li Moumou, a villager in Bakenzhong Village, Yikengzhong Township, Ningcheng County, Chifeng City, Inner Mongolia Autonomous Region

After investigation by the Ningcheng County Medical Insurance Bureau, Chifeng City, the insured The person Li Moumou had the illegal fact of using the medical insurance fund to reimburse 38,964.66 yuan in medical expenses from 2017 to 2019 (the expenses should not be paid by the medical insurance fund) by deliberately concealing third-party liability, and was suspected of insurance fraud.

On April 2, 2020, the local court made the following verdict: The defendant Li Moumou committed the crime of fraud and was sentenced to one year and six months in prison, suspended for two years. The proceeds of RMB 38,964.66 will be returned to the fund account of the Medical Insurance Center, and a fine of RMB 5,000 will be imposed.

7. Insurance fraud case involving Zhu Moumou in Lianyungang City, Jiangsu Province

After investigation by the Lianyungang Municipal Medical Insurance Bureau, it was found that Zhu Moumou, the daughter-in-law of Bi Moumou, an insured person, had an affair with Dr. Jiang Moumou. The illegal fact of deliberately concealing third-party liability and using the medical insurance fund to reimburse medical expenses of 22,859.82 yuan (this expense should not be paid by the medical insurance fund) by forging the contents of the "Trauma Approval Form" is suspected of fraud. After the case was transferred to the Haizhou Public Security Bureau of Lianyungang City, it was verified that the above situation was true.

The verdict of the local court is as follows: The defendant Zhu Moumou committed the crime of fraud and was sentenced to six months in prison, suspended for one year, and fined RMB 20,000. RMB 22,859.82 was returned to the fund account of the medical insurance center.

8. The insurance fraud case of insured person Yang Moumou in Lai'an County, Chuzhou City, Anhui Province

After investigation by the Medical Insurance Bureau of Lai'an County, Chuzhou City, the insured person Yang Moumou intentionally He was suspected of defrauding 155,000 yuan in medical expenses by forging three hospitalization invoices to prepare for medical insurance reimbursement. After the case was handed over to the police, it was verified that the above situation was true.

The local court’s verdict was as follows: The defendant Yang Moumou was guilty of fraud (attempted) and was sentenced to three years in prison, suspended for three years, and fined 20,000 yuan.

9. The case of misappropriation of public funds by Yang Moumou of the Pu'er Medical Insurance Management Center of Yunnan Province

An investigation by the Pu'er Municipal Medical Insurance Bureau found that Yang Moumou, the former chief of the Financial Statistics Section of the Pu'er Medical Insurance Center Suspected of misappropriating medical insurance funds. After the case clues were handed over to the Pu'er Municipal Commission for Discipline Inspection and the Public Security Bureau for further investigation, the evidence was identified, all illegally obtained funds were recovered and returned to the fund account of the Medical Insurance Center.

The local court ruled as follows: Yang Moumou, the former chief of the Financial Statistics Section of the Pu'er Medical Insurance Center, misappropriated public funds of RMB 947,836.89, constituting the crime of embezzlement of public funds and was sentenced to two years in prison and suspended for two years.

Guangzhou Daily-The National Medical Insurance Bureau exposed 9 cases of fraud and insurance fraud, involving directors of multiple hospitals