Anhui reported 5 cases of suspected insurance fraud and defrauding money. What should people who really need it do?

Those who really need it can only get insurance compensation through the relevant insurance companies. This incident happened in Taihe County, Anhui Province. A local hospital was investigated by the police for allegedly defrauding insurance companies. After investigation, it was found that this place provided free food and accommodation, free physical examinations, and cars. Transportation can also lower admission standards and other conditions to induce patients to be hospitalized. Among them, there are false cases and imposters, or over-treatment, as well as irrational medication use. The amount currently involved is as high as more than 2 million. This incident also resulted in four hospitals being terminated from their medical insurance settlement agreements, and the responsible doctors were severely punished. The relevant illegal amounts have been recovered by the police, and these cases have been transferred to the police for processing.

Because the medical insurance fund is actually the people’s life-saving money and medical treatment money, and judging from the information released by the National Medical Insurance Administration, in 2020, actions and surprise inspections have been carried out to combat medical insurance fraud. . Throughout 2020, the People's Government of China has dealt with 390,000 medical institutions that violated relevant laws and regulations. The amount recovered was as high as 22 billion yuan.

In fact, their method is to defraud insurance through falsehoods. First of all, the diagnosis is fake, the patient is also pretended to be an actor, and the ward is empty and unavailable, but various accidents continue to happen. Consumption. These are used to defraud insurance. And this is a complete industrial chain. First, an agency searches for the elderly to be hospitalized, but the doctor customizes a fake case for him. Some elderly people are hospitalized up to 9 times for free in a year. The entire process involves finding people to be hospitalized through an intermediary, the hospital inducing the patient to be hospitalized, and then pretending to be a patient to collect money. This is a three-step process to achieve insurance fraud. This incident has aroused great concern among the general public.

There are many reasons why hospital insurance fraud has not been banned. First of all, it has to do with the imperfect supervision system. If the supervision system is not perfect enough, there will be loopholes in the relevant criminals to compensate. And the corresponding restraining mechanism is not perfect enough. Because the restraining mechanism is not perfect enough, the other party feels that there is an opportunity. In addition, medical insurance funds are involved in a very wide range of supervision, and the fields involved include medicine, law, and auditing. Therefore, the relatively weak laws have given loopholes to criminals, leading to frequent insurance fraud. Now the country has dealt with this matter seriously and strictly supervised it to prevent it from happening again. There is also a special management and review work. We are also launching a concentrated crackdown on malicious insurance fraud involving fake patients and fake medical conditions.