Text: The last elder brother
Editor: The last elder brother
———Foreword———
Recently, a blockbuster news about Wuxi Hongqiao Hospital's suspected insurance fraud shocked the entire medical industry and touched the heartstrings of countless people. This private medical institution, under the glamorous surface, hides such a despicable secret. With an announcement from the Wuxi Municipal Medical Insurance Bureau, a storm of justice against medical insurance fraud is sweeping.
Every word of the administrative case and comprehensive investigation reveals the government's zero-tolerance attitude towards this matter. So, behind this storm, what legal responsibilities will the people involved face? How will their actions affect our healthcare environment? Today, let's unveil the mystery of this insurance fraud case together.
[Foreword: Medical Chaos in the Shadow of Insurance Fraud]
Medical insurance fraud, a word that sounds chilling, has been repeatedly staged in reality. The suspected insurance fraud incident of Wuxi Hongqiao Hospital is only the tip of the iceberg, but it is enough to give people a glimpse of all kinds of chaos in the medical field. Insurance fraud not only erodes the safety of the national medical insurance fund, but also makes countless patients bear unnecessary financial burdens, destroying the bridge of trust between doctors and patients. Therefore, the decisive action of the Wuxi Medical Insurance Bureau is undoubtedly a powerful response to this illegal behavior, and it is also a resolute defense of social fairness and justice.
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[Event review: The doctor's real-name report unveils the shady curtain of insurance fraud]
It all started with the real-name reports of the two doctors. Dr. Zhu Chenggang and Dr. Li from the Department of Radiology and Imaging of Wuxi Hongqiao Hospital found many doubts in their daily work. They found that some patients did not have an image number in their medical records, nor did they have corresponding CT or MRI images, but the medical records were marked with the words "diagnosed according to imaging". These obviously contradictory medical records aroused their high vigilance.
As the investigation deepened, more shocking details emerged. Dr. Zhu Chenggang showed reporters photos of the medical records of 99 "patients", which were diagnosed from July to December 2022 and April 2023, and the age group was between 60 and 80 years old.
What is even more shocking is that there are many of these medical records that use the same CT scan as the basis for diagnosis. For example, in the medical records of 72-year-old "Yang Moumou" and 62-year-old "Qiu Moumou", although the diagnosis time is different, the CT images are surprisingly similar, and it can even be clearly seen that the shape, size and position of the pendants worn by the two patients are basically the same.
[Official response: administrative filing, comprehensive and thorough investigation]
In the face of such serious accusations, the Wuxi Municipal Medical Insurance Bureau reacted quickly. In the early morning of September 22, the bureau issued an announcement in response, saying that it had accepted the investigation and preliminary verification according to the report clues, and filed an administrative case on August 30. At present, we are conducting a comprehensive and thorough investigation with the public security, health and other departments, and will seriously investigate and deal with it in accordance with laws and regulations. This announcement has undoubtedly reassured the public and demonstrated the government's firm determination to crack down on medical insurance fraud.
[Legal analysis: What responsibilities will the people involved face?] 】
1. Civil Liability
The persons involved are first and foremost liable for civil liability. According to the Tort Liability Law of the People's Republic of China and other relevant laws and regulations, if the insurance fraud causes losses to the national medical insurance fund or the patient, the insurance fraudster shall be liable for compensation. This includes, but is not limited to, the return of fraudulent medical insurance funds, compensation for additional costs incurred by patients due to false diagnoses, etc.
2. Administrative Liability
The filing of an administrative case means that the insurance fraud has violated administrative laws and regulations. According to the Social Insurance Law of the People's Republic of China and other regulations, once insurance fraud is confirmed, the insurance fraudster will face severe administrative penalties. This can include hefty fines, revocation of practice qualifications, restrictions on practice, etc. For medical institutions, they may also face penalties such as suspension of business for rectification and revocation of practice licenses.
3. Criminal Liability
If the circumstances of the insurance fraud are serious and it is suspected of constituting a crime, the insurance fraudster will also face criminal liability. According to the relevant provisions of the Criminal Law of the People's Republic of China, the crimes of fraud, corruption and other crimes may be applied to such insurance fraud. If convicted, the scammer faces severe penalties of imprisonment, detention, fines and even confiscation of property.
[Justice may be late, but it will never be absent]
The exposure and handling of the suspected insurance fraud incident of Wuxi Hongqiao Hospital is not only a severe punishment for individual criminals, but also a warning to the entire medical industry. It tells us that no matter what industry we are in or what position we have, we must stick to the bottom line of law and morality. Insurance fraud not only harms the public interest and the rights and interests of others, but also seriously tarnishes one's career and social reputation.
Justice may be late, but it will never be absent. The decisive actions of the Wuxi Municipal Medical Insurance Bureau, public security, health and other departments have shown us the government's firm determination and effective measures to crack down on medical insurance fraud. We also hope that this storm will completely eliminate the black sheep in the medical field and restore a clear and fair medical environment for the majority of patients. At the same time, we also call on the whole society to pay attention to and support the safety and stability of the medical insurance fund, and jointly safeguard the medical rights and interests of each of us.