In a small village in Ganzhou, Jiangxi Province, the originally peaceful life was shattered by a medical insurance fraud case. Xiao, the person in charge of the village clinic, thought that he had found a "way to make money by accumulating a small amount", but he was clever and mistaken by cleverness, and finally fell into the legal net, paying a heavy price for his actions.
Xiao ran the village clinic locally, and perhaps at the beginning, he also had the original intention of being a doctor, helping the world, and relieving the pain of the villagers. However, I don't know when greed quietly grew in his heart, and he had a bad idea. In November 2021, Ganzhou City launched a special rectification action for the illegal use of medical insurance funds by grassroots medical institutions, and Xiao's illegal behavior was also unveiled at this time.
Through the screening and analysis of the medical insurance settlement data of primary medical institutions that year, the medical insurance department found that the village clinic in charge of Xiao had an abnormal increase in the number of visits by some young insured. Some insured people have seen as many as 71 visits in 11 months, an anomaly that has aroused the high alarm of the health insurance department. After an in-depth investigation and verification, a shocking truth emerged. Xiao persuaded his relatives and friends to leave 23 social security cards in his clinic on the grounds that it was convenient for them to seek medical treatment and buy medicines and avoid losing their social security cards.
Xiao used these collected social security cards to falsely prescribe outpatient prescriptions to defraud medical insurance reimbursement. In order to avoid the supervision of the medical insurance department, he racked his brains and tried his best to prescribe each social security card every few days, and the cost of a single prescription was controlled below 100 yuan. He thought that his plan was seamless and seamless, but he didn't know that the legal net was magnificent, negligent but not leaky. From January 1 to November 26, 2021, Xiao used these 23 social security cards to falsely prescribe outpatient prescriptions for 1,313 times, with an average of 57 times per card, defrauding the medical insurance fund of 38,000 yuan. This figure may be regarded as a "huge amount of money" for a village clinic. However, this money is built on the basis of violating the law and committing crimes, which is a serious erosion of the medical insurance fund and a serious damage to the rights and interests of the vast number of insured people.
Xiao's behavior is undoubtedly a blatant challenge to national laws. The Regulations on the Supervision and Administration of the Use of Medical Security Funds clearly stipulate that designated medical institutions that induce or assist others to seek medical treatment or purchase drugs under false names or falsely, or fabricate medical service items will face severe punishments, and the Criminal Law also makes clear sentencing provisions for fraud of public and private property. Xiao's act of collecting other people's social security cards and falsely prescribing them for medical insurance reimbursement is a typical fraud and insurance fraud. In order to avoid regulatory penalties, he deliberately controlled the frequency of card swiping and reduced the average fee, thinking that he was smart and secretly proud, but he did not know that this had constituted an intentional crime. In the end, the court sentenced Xiao to 10 months in prison and a fine of 8,000 yuan for fraud in accordance with Article 266 of the Criminal Law.
Xiao's case is a wake-up call. The medical insurance fund is the people's "medical money" and "life-saving money", which is related to everyone's life and health and family happiness, and any attempt to defraud the medical insurance fund is a blasphemy of the law and a destruction of social fairness and justice. Xiao could have won everyone's respect and trust by legally operating a clinic to provide high-quality medical services to the villagers, but he was blinded by greed and chose a wrong path that he regretted.
In this case, we also see the responsibility and action of the medical insurance department. In the special rectification action, the medical insurance department discovered the abnormal situation in a timely manner through the screening and analysis of the medical insurance settlement data, and quickly launched an investigation. They were not afraid of difficulties, went deep into the grassroots, did not let go of any clues, and finally brought Xiao's illegal and criminal acts to justice. At the same time, the medical insurance department also actively publicizes the medical insurance policy and reminds the majority of the insured to jointly maintain the safety of the medical insurance fund. By announcing the hotline for cracking down on fraud and insurance fraud, they encouraged the public to actively report suspected fraud and insurance fraud, and rewarded whistleblowers once the clues were verified, up to 200,000 yuan. This practice not only effectively cracks down on fraud and insurance fraud, but also fully mobilizes the enthusiasm of the masses to participate in the supervision of medical insurance funds.
It is the responsibility of each and every one of us to maintain the safety of the medical insurance fund. The vast number of insured people should enhance their legal awareness, consciously abide by the medical insurance policy, and not participate in any fraud and insurance fraud. At the same time, we should also actively pay attention to the use of the medical insurance fund, and report to the medical insurance department in a timely manner if we find suspected fraud and insurance fraud. Only by thinking in one place, working hard in one place, and working together, can we ensure the safe operation of the medical insurance fund, so that the medical insurance fund can truly play the role of "medical money" and "life-saving money".
For medical institutions and pharmaceutical practitioners, it is more important to adhere to professional ethics and operate legally and compliantly. Medical institutions should strengthen internal management, establish and improve the medical insurance management system, strictly review medical insurance reimbursement vouchers, and put an end to the occurrence of fraud and insurance fraud. Pharmaceutical practitioners should improve their own quality, establish correct values, focus on the life and health of patients, and provide patients with high-quality medical services. Only in this way can we win the trust of patients and the recognition of society and achieve our own sustainable development.
Xiao's incident has come to an end, but the reflections it leaves us are far from over. We should learn from this case, always keep a clear head, and stay away from the path of breaking the law and committing crimes. Let us work together to protect the medical insurance fund, which is the people's "medical money" and "life-saving money", and contribute to building a harmonious society and protecting people's health.
In this complex society, we are often faced with various temptations. Some people can stick to the bottom line and remain unmoved; However, some people lose themselves in the face of temptation and embark on the road of breaking the law and committing crimes. Xiao is a typical representative of the latter. He originally had a stable life and career, but because of a momentary greed, he ruined his bright future. This case tells us that we must be honest and trustworthy, abide by the law, and not leave anything to chance and try to obtain benefits through improper means.
The medical insurance fund is a special fund set up by the state to ensure the basic medical needs of the people, and its security is related to the vital interests of everyone. We should take care of the medical insurance fund as we love our own eyes, and work together to resist insurance fraud. Only in this way can we ensure the sustainable development of the medical insurance fund and provide more reliable medical security for the broad masses of the people.
This case has sounded the alarm for us, and I hope that everyone can learn a lesson from Xiao's case, take it as a warning, and let us work together to maintain the safety of the medical insurance fund and contribute to the realization of the Chinese dream of the great rejuvenation of the Chinese nation.
Topic of this issue: What do you think about this topic?
Source: Official website of the National Healthcare Security Administration
Editor: Liangyou
Review: Hongyi
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