Keep the people "see a doctor"

The medical insurance fund is the "seeing the money" and "life -saving money" of the people, but there are such groups of people watching the money and moving their brains.

They spent money to rent a medical insurance card for others. In the major hospitals, they used the identity of the elderly to buy drugs for sale at a low price. In 8 months, they cheated more than 1 million yuan in medical insurance funds.

A few days ago, the People's Procuratorate of Baoshan District of Shanghai filed a public prosecution on the fraud case.

The amount of medical insurance fraud cases involved in more than 100 million yuan

In July 2021, the staff of the Medical Security Bureau reported that Xu, Tanmou and others used social security cards to deceive the national medical insurance fund many times. The public security organs conducted in -depth investigations of Xu, Tan, and others. The main criminals of the case Wang, Li and others gradually surfaced.

"When I passed by a pharmacy, a man came up to ask me if he was willing to lend the medical insurance card to him. Each use will give me the benefits of 200 yuan. I was greedy for a while and agreed to him." Xu explained, She is a nanny of her home and is responsible for taking care of the elderly Lu, because she often takes Lu to see a doctor, and she keeps Lu's medical insurance card. After meeting the man Wang, Xu lent Lu's medical insurance card to Wang from time to time. Wang returned the card after use, and paid the benefits of 200 yuan to Xu. In this way, Xu made a total of 2,000 yuan by borrowing Lu's medical insurance card.

Like Xu, the same person also mentioned the same person, Wang. According to the relevant clues, the police arrested Wang, Li and others after investigation, and seized more than 50 boxes of hospitals and invoices for more than 700 boxes of hospitals and invoices.

According to the survey, Wang was sentenced to two years in prison for illegal business crimes for selling medical insurance in October 2015. Li is a distant relative of Wang's wife. In January 2021, the two of them together, and they moved the crooked brain to deceive the medical insurance fund for selling medicines.

"You lend me the medical insurance card. I will give you 200 yuan a month." Wang, who was originally squatting at the entrance of hospitals, pharmacies, and supermarkets, and recycled the drugs from the elderly at a high price, he began to rent medical insurance card from these elderly people. Some people can't stand the temptation of money and lend their medical insurance cards to Wang. After receiving the medical insurance card, Li will go to several designated hospitals to find a fixed doctor to swipe the card to open the prescription, and then pay the medical insurance card and prescription to pay the medicine. After that, Wang and Li resold these medicines for profit. After a preliminary investigation, the amount involved in the case reached more than 100 million yuan.

Intervention in advance digging the crime chain in advance

After the case, the prosecutor of the Baoshan District Procuratorate across the region and involved a wide range of places in response to the location of the case. The case was ganged and concealed. The question was decided to intervene in advance and guide the public security organs to fix the evidence such as chat records, medical transaction records, and hospital monitoring videos.

At the same time, the public security organs are required to formulate an outline of the interrogation to conduct a detailed understanding of criminal facts, criminal amounts, and personnel involved.

In addition, through the interrogation of the suspect, investigating and chatting records and payment exchanges, the joint medical security bureau screened abnormal medical treatment, and dug the suspects of the same case.

After a period of investigation, all other persons involved had all the cases. Among them, Sun Mou and Zhang, who acquired the medicine, is an important part of the crime chain in the case.

Sun was engaged in the management of pharmacy warehouses in the hospital and registered the inlet and outbound database of drugs. According to Sun's explanation, when some drug dealers went to his hospital to prescribe medicine, he took the initiative to add his WeChat to ask if there is a medicine they need. If the number of medicines is not enough, it will ask Sun to release more from the warehouse. Sun Mou said that the reason why he agreed to the drug dealers had his own considerations, because if the medicines in the pharmacy could not be sold, they needed to bear the expenses of expired medicines. Therefore, in order to avoid losses, he will find a drug dealer for help. Of course, he still has to ensure that patients who come to the hospital to see a doctor can get the medicine and not give all the medicines to the drug dealers. Sun said that the most diligent medicine dealer with him was Li, basically he prescribed medicine every week, and there were more medical insurance cards in his hand. Moreover, Li was generous and often sent him a red envelope.

These medicines prescribed from the hospital through illegal channels were eventually sold to others. Wang's fellow Zhang is one of the "profit people". Zhang Mou knows that Wang is a pharmaceutical dealer. He is engaged in the behavior of buying medicines at a low price. He still acquires medicines from Wang three times. After buying the medicine, Zhang took a long -distance car and returned to his hometown, selling the medicine to the local private clinic, and made a profit from it.

Based on Wang's confession, chat records, and money exchanges, the data screening and analysis of the medical security bureau was determined by the remaining insureds who were suspected of lending medical cards in violation of regulations.

Guide the investigation of the public prosecution on the person involved

After the case is transferred to the censorship and arrest

The prosecutor's review believes that the existing evidence can determine that the actions of Wang, Li, and Zhang have been suspected of crime, and the amount has reached huge and larger. Considering that there is still a criminal facts in this case, they need to be further verified, so the three of them are for three people. Make an arrest decision.

To further improve the evidence

The prosecutor will continue to investigate and obtain evidence from the public security organs: verify the medical insurance card involved in the case and seize it; the facts of the criminal facts of some medical insurance cards shall be fixed to the criminal facts of obtaining medical insurance for medical insurance Check the verification and verification; arrange witnesses, and the same case personnel to identify Wang and Li.

at the same time

In the case, a large number of insured persons knew that Wang's card intention was still borrowed from the medical insurance card. It was used for fictional diseases, deceiving medicines, and fraudulent medical insurance funds, and the amount reached tens of thousands of yuan, respectively. Their actions have led to a large amount of losses in the medical insurance fund, seriously damaging the management order of the medical insurance industry, and have been suspected of crime. To this end, the prosecutor filed a prosecution on 31 serious medical insurance cards. Eventually verified

Wang Mou, with Li, from Xu, Tan and others at a price ranging from 200 yuan to 400 yuan per month, borrowed medical insurance cards held by Xu, Tanmou, etc., and in major hospitals in this city. On the grounds of seeing a doctor, use the elderly to buy related drugs at a low price, and then resold to profit. In 8 months, a total of more than 100 million yuan of medical insurance funds were cheated.

For the purpose of illegal possession, Zhang knew that the medicine was the stolen goods obtained by Wang for the crime. He still acquired from Wang in three times and sold the stolen money.

Wang, Li Mou's fictional facts, concealing the truth, scamming medical insurance fund, the amount is particularly huge, Zhang Mou knows that it is the stolen goods from the criminal, and concealed and concealed it. The facts of the crime are clear. Li Mou filed a public prosecution in order to cover up and conceal the crime of crime to Zhang Mou.

A few days ago, the court was sentenced to seven months in prison for covering up and concealing the crime of crime, and fined 2,000 yuan. The case of Wang and Li is under trial. The criminal facts of other cases in the case are under further verification.

In addition to the case, the prosecution of the case is recommended to block the construction system

During the process of handling the case, the prosecutor also found that Li was able to hold a number of medical insurance cards with different insured persons in a day, and unimpededly assigned medicines and medicines in the hospital. This abnormal behavior was not discovered and stopped by the hospital. Essence Some doctors and pharmacy staff in the hospital are not strictly checked, even internal and external, and the hospital management has loopholes. Some doctors and staff have negligent work, providing the opportunity for these criminals to distribute medical insurance funds for illegal drug fraud.

To this end, the prosecutor issued procuratorial suggestions for the relevant functional departments of the two districts: to check the shortage of missing and leakage in time, strengthen the supervision obligations of the hospitals in the area, and establish a sound supervision mechanism; "Notice of Patrol Management", strengthen the education of doctors and pharmacy staff, find problems in time to rectify problems; doctors and pharmacy staff should further strengthen their sense of responsibility, carefully review the subject responsibilities of whether the appointment staff meets the relevant regulations, and adhere to the prevention of illegal medical fraud fraudulent fraud The line of defense of the medical insurance fund.

The relevant functional department wrote a letter of repurchase the comprehensive supervision and inspection of the practice of the hospital involved in accordance with the law, and found that the hospital had the establishment of and inadequate the establishment of a drug system. Has been rectified. For medical institutions to strengthen the training of relevant laws and regulations, raise the awareness of the rule of law of the institution, incorporate the supervision of substitutes for medical institutions in accordance with the law, and request medical security designated units to implement 100 % self -management of the agency. And standardize awareness of practice. Standardize the prescription and review and distribution of the prescription of the medicine on behalf of the drug.

Next, relevant departments will also establish and improve supervision mechanisms to strengthen supervision in accordance with relevant health laws and regulations; actively cooperate with the medical insurance department to supervise the medical insurance fund; increase investigation and punishment, and severely punish illegal activities in medical practice.

Prosecutor reminds

For the criminal behavior of such fraud medical insurance funds, the judicial organs will increase their blows, cut off the illegal interest chain, punish related personnel such as professional cardholders, illegal trading drugs, etc., and resolutely keep the people "seeing the doctor", "life -saving money" "".

The general public should pay attention to, we must keep their medical insurance cards, and do not lend to others at will. If the insured is inconvenient to act and requires other people on behalf of the medicine, it shall abide by the "Notice on the Relevant Regulations on the Relevant Regulations of the Datoming of Pinsented Dattle of the Outpatient Medical Institution of Medical Insurance".

If you find illegal criminal clues such as illegal acquisition of medical insurance and drugs to rent a medical insurance card set for medical insurance, please report to the public security organs in time.

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