Recovered more than 12 million!

Recently, Shandong Provincial Medical Security Bureau exposed 16 typical cases of illegal use of medical security funds
.
At present, these 16 cases have recovered 12.
6236 million of medical insurance funds, 4 rectification within a time limit, suspension of medical insurance services of 1 medical institution, suspension of medical insurance settlement and service of 2 medical institutions, dissolution of medical insurance agreements of 2 medical institutions, and suspension of personal medical care One person for online settlement of expenses, 4 administrative penalties, fines of 640,600 yuan, 3 transfers to judicial organs, 14 fixed-term imprisonment, 4 arrests in accordance with the law, and 6 releases pending trial, forming a powerful deterrent
.
Attachment: Typical cases of illegal use of medical security funds 1.
Jinan Laiwu Yineng Mining Co.
, Ltd.
Staff Hospital fraudulently obtained medical insurance funds after verification, from January to November 2020, Laiwu Yineng Mining Co.
, Ltd.
Staff Hospital had forged medical documents The illegal act of defrauding the medical insurance fund involved an illegal amount of 9,873 yuan; at the same time, the hospital also had problems with illegal fees and providing medical insurance settlement services for non-designated medical institutions, involving an illegal amount of 155,500 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and the "Medicine Service Agreement of Jinan Basic Medical Insurance Designated Medical Institutions", the medical insurance department recovered 155,500 yuan of illegal expenses, ordered the hospital to return the defrauded medical insurance fund of 9,873 yuan, and imposed an administrative penalty of 29,619 yuan.
Cancel the service agreement of designated medical institutions with basic medical insurance with the hospital
.
2.
Qingdao Hengbo Cardiovascular and Cerebrovascular Disease Hospital fraudulently defrauded medical insurance funds.
From July 2019 to December 2020, Qingdao Hengbo Cardiovascular and Cerebrovascular Disease Hospital has suspected of forging color Doppler ultrasound inspection reports and illegal use of medical insurance funds.
The amount of violation of laws and regulations was 3,704,100 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China", "Qingdao Municipal Social Medical Insurance Measures" and "Qingdao Social Medical Insurance Designated Medical Institution Medical Service Agreement", the medical insurance department recovered 3.
7041 million yuan of illegal fees and cancelled the medical insurance signed with the hospital The service agreement was transferred to the local public security agency for investigation on suspected forgery of color Doppler ultrasound report
.
On June 20, 2021, the case was approved by the prosecutors, 4 people were arrested and 6 people were released on bail pending trial
.
3.
The case of illegal use of medical insurance funds by Huantai Jimin Hospital in Zibo City After verification, from January 2018 to December 2020, Huantai Jimin Hospital had problems such as illegal charges, involving an illegal amount of 1,688,400 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and the "Zibo City Basic Medical Insurance Hospitalization Designated Medical Institution Medical Insurance Service Agreement", the medical insurance department interviewed the person in charge of the hospital, recovered 1,688,400 illegal expenses and suspended the hospital's surgical medical insurance service for 3 months
.
4.
Sun Mou, a participating resident in Taierzhuang District, Zaozhuang City, fraudulently defrauded the medical insurance fund.
After verification, Sun gave his medical insurance certificate to his twin brother on May 23 and June 19, 2020, and used it under his own name at a designated location in Zaozhuang.
Hospital reimbursement for medical expenses totaled 153,400 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China", the medical insurance department recovered 153,400 yuan of illegal fees and transferred them to the local public security agency
.
5.
Case of illegal use of medical insurance fund by Dongying Traditional Chinese Medicine Hospital After verification, from January 2018 to July 2020, Dongying Traditional Chinese Medicine Hospital had problems such as unreasonable charges and medication beyond the scope of indication restrictions, involving an illegal amount of RMB 26,228.
87
.
In accordance with the "Social Insurance Law of the People's Republic of China" and the "Dongying City Basic Medical Insurance Designated Medical Institution Medical Service Agreement", the medical insurance department recovered 26,228.
87 yuan in violation of the regulations
.
6.
The case of illegal use of medical insurance funds by Yantai Central and Large Anorectal Hospital In April 2021, after verification by the local medical insurance department, it was found that Yantai Central and Large Anorectal Hospital had problems such as unreasonable charges, over-limitation of medical insurance drug payment, and excessive inspections, involving illegal amounts 476,000 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and "Yantai City Basic Medical Insurance Service Agreement", the medical insurance department recovered 476,000 yuan of illegal expenses and ordered the hospital to rectify within a specified period of time
.
7.
The case of illegal use of medical insurance funds by Zhucheng Boji Hospital in Weifang City After verification, from January 2019 to April 2021, Zhucheng Boji Hospital had problems with over-standard charges and over-restricted medication, involving an illegal amount of 1.
098 million yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and the "Zhucheng Basic Medical Insurance Service Agreement", the medical insurance department recovered 1.
098 million yuan of illegal expenses
.
8.
Jincheng Street (Zhonghe) Community Health Service Center in Rencheng District, Jining City, after verification of the case of illegal use of medical insurance funds, Jincheng Street (Zhonghe) Community Health Service Center in Rencheng District, Jining City from January 1, 2018 to June 2020 During the 30 days, there were illegal use of medical insurance funds such as uploading medical insurance settlement system items corresponding to errors, lowering the standard admissions for hospitalization, and exceeding standard charges, which involved an illegal amount of 990,000 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and the "Medical Service Agreement of Comprehensive Designated Medical Institutions in Rencheng District of Jining City", the medical insurance department recovered 990,000 yuan of illegal expenses
.
9.
Taian Xintai Liudu Center Health Center fraudulently defrauded medical insurance funds in April 2021, after verification by the local medical insurance department, it was discovered that there were over-standard charges, false charges, and other illegal use of medical insurance funds in the Liudu Center Health Center of Xintai City.
, Involving an amount of 25,636 yuan in violation of laws and regulations
.
In accordance with the "Social Insurance Law of the People's Republic of China" and "Tai'an City Basic Medical Insurance Designated Medical Institution Service Agreement", the medical insurance department recovered 25,636 yuan in violation of laws and regulations, and imposed an administrative penalty of 76,908 yuan
.
10.
Weihai Great Wall Hospital Co.
, Ltd.
Traditional Chinese Medicine Hospital illegally used medical insurance funds in November 2021.
After verification by the local medical insurance department, it was discovered that Weihai Great Wall Hospital Co.
, Ltd.
Traditional Chinese Medicine Hospital had problems such as exceeding medical insurance restrictions, unreasonable charges, and irregular medical records management.
The amount of violation involved is RMB 94,559.
01
.
In accordance with the "Social Insurance Law of the People's Republic of China", "Regulations on the Supervision and Administration of the Use of Medical Security Funds", "Weihai Basic Medical Insurance Comprehensive (Specialized) Designated Medical Institution Service Agreement", the medical insurance department recovered 94559.
01 yuan of illegal expenses and suspended medical insurance settlement 3.
Months
.
11.
Rizhao Central Hospital's illegal use of medical insurance funds After verification, from January 2018 to June 2020, Rizhao Central Hospital had illegal use of medical insurance funds such as over-range medication, involving an illegal amount of 976,200 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and "Rizhao City Basic Medical Insurance Designated Medical Institution Service Agreement", the medical insurance department ordered the hospital to make rectification within a time limit and recover 976,200 yuan of illegal expenses
.
12.
Linyi High-tech Hospital Co.
, Ltd.
fraudulently defrauded medical insurance funds.
After verification, Linyi High-tech Hospital Co.
, Ltd.
had problems with the illegal use of medical insurance funds such as bed hanging and hospitalization, involving an illegal amount of 1,141,900 yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and "Linyi Basic Medical Insurance Designated Medical Institution Medical Service Agreement", the medical insurance department recovered 1,141,900 yuan of illegal expenses, interviewed the main person in charge of the hospital, and ordered the hospital to rectify within a specified period of time.
The clues of the problem are transferred to the local comprehensive administrative law enforcement department
.
13.
Dezhou Decheng District Rehabilitation Hospital used medical insurance funds in violation of regulations.
After verification, the hospital had behaviors such as the use of drugs exceeding medical insurance payment restrictions, exceeding standard charges, and alteration of medical items, involving an illegal amount of 118,425.
13 yuan (including 39,060 of the funds for the alteration of items).
Yuan)
.
In accordance with the "Social Insurance Law of the People's Republic of China" and "Dezhou Basic Medical Insurance Designated Medical Institution Service Agreement", the medical insurance department interviewed the person in charge of the hospital and ordered immediate rectification of the violation; the violation fee was recovered at 118,425.
13 yuan and an administrative penalty was 78,120 yuan.

.
14.
Liaocheng Cervical and Lumbar Spondylosis Hospital Illegal Use of Medical Insurance Funds After verification, from 2020 to January 2021, Liaocheng Cervical and Lumbar Spondylosis Hospital used medical insurance funds in violation of diagnosis and treatment regulations, involving an illegal amount of 1.
4139 million yuan
.
In accordance with the "Social Insurance Law of the People's Republic of China" and the "Medical Service Agreement of Basic Medical Insurance Designated Hospitals in Dongchangfu District, Liaocheng City", the medical insurance department interviewed the person in charge of the hospital and recovered 1.
4139 million yuan of illegal expenses from March 30 to May 5 On June 6, the hospital’s designated basic medical insurance services were suspended, and the agreement will not be renewed after expiration
.
15.
Binzhou Huimin Sunshine Hospital fraudulently defrauded medical insurance funds.
After verification, from June 2017 to October 2018, Binzhou Huimin Sunshine Hospital had a total of 174 hospitalizations of fictitious patients, defrauding medical insurance funds of 492,500 yuan
.
The medical insurance department rescinded the hospital's medical insurance service agreement in accordance with the "Social Insurance Law of the People's Republic of China" and "Binzhou Basic Medical Insurance Designated Medical Institution Service Agreement"
.
In September 2020, among the 14 people involved in the court, Chen XX was sentenced to six years imprisonment, Lin XX was sentenced to four years imprisonment, and the remaining 12 people including Liu XX were sentenced to three to seven months imprisonment.
The execution was suspended, and a total fine of 456,000 yuan was imposed
.
16.
The case of Huang Moumou’s repeated reimbursement of hospitalization expenses in Dingtao District, Heze City was verified.
In January 2019, Huang Moumou was hospitalized in a Beijing hospital and settled on the Internet, and then returned to the insured area (Dingtao District) for a second reimbursement.
The amount of hospitalization was 45,300 yuan, the amount of serious illness insurance was 13,700 yuan, and the repeated enjoyment of medical insurance benefits in violation of regulations caused a loss of 59,000 yuan to the medical insurance fund
.
In accordance with the "Social Insurance Law of the People's Republic of China" and the "Medical Service Agreement of Basic Medical Insurance Designated Medical Institutions in Dingtao District, Heze City", the medical insurance department ordered Huang to return 59,000 yuan to the medical insurance fund and suspend the online settlement of medical expenses for 4 months
.