How does the Medical Insurance Bureau detect insurance fraud?

They all have special departments to detect insurance fraud, and people with investigative experience are responsible for this task. It is better to be responsible for their duties. Medical insurance fraud cannot be accomplished by an individual, and the only way is to cooperate with the hospital. There are so many ways to investigate and deal with it. Even the hospital knows it, but you know it is useless.

Medical insurance funds are "life-saving money" for ordinary people. The National Medical Security Administration recently stated that after a period of special rectification, positive progress has been made in investigating and handling the problem of defrauding medical security funds by designated medical institutions and retail pharmacies. Since the launch of the special rectification, 91,600 designated medical institutions nationwide have been investigated and punished for fraud and insurance fraud, 2.632 billion yuan in medical insurance funds and liquidated damages have been recovered, and administrative fines of 194 million yuan have been imposed; 63,900 designated pharmacies have been investigated and punished for fraud and insurance fraud, and 2.632 billion yuan in medical insurance funds and liquidated damages have been recovered. Return to the medical insurance fund and liquidated damages of 214 million yuan, and impose an administrative fine of 5 million yuan.

Since September 2018, the National Medical Insurance Administration, together with the National Health Commission, the Ministry of Public Security, and the State Food and Drug Administration, have jointly launched a special operation to crack down on fraud and defrauding medical security funds, and organized unannounced inspections. Unannounced inspection is a form of follow-up inspection, which refers to an on-site inspection carried out without prior notification to the inspected department. It is an effective way to severely crack down on various types of fraud and insurance fraud. Up to now, the National Medical Insurance Administration has conducted 39 groups of unannounced inspections and completed on-site inspections in 30 provinces (autonomous regions and municipalities). It was initially confirmed that the illegal amount was nearly 250 million yuan, and the inspected units took the initiative to refund more than 200 million yuan, realizing the realization of various measures. The high-pressure deterrence of fraud-like insurance breaches and violations has formed a regulatory demonstration effect.

At the same time, in order to give full play to the role of public supervision and guide the public to actively participate in special rectification, the National Medical Insurance Administration has set up a special rectification column on the official website of the bureau, WeChat official account, etc. to announce the reporting methods and public rectification to the public. Project and notification work progress. According to reports, since the special rectification, the special reporting and complaint hotline, WeChat reporting platform, online petition system and other reporting acceptance platforms have received 12,841 reporting clues and handed them over to various provinces (autonomous regions and municipalities) since the special rectification. 13 batches of 1,586 clues, of which the first 10 batches have reached the settlement time limit, with a settlement rate of 83.9%, and the amount of fraud and insurance fraud investigated was 220 million yuan