Put an end to insurance fraud not only see the "acting" 
 
 

The 2015-03-12 07:34:35 
 
 
Source: health 
 
 
Chung chi xia (doctor) 

    In May 2013, suzhou city, jiangsu province social security fund center through the masses to report and view the surveillance, wuzhong district found five abnormal shop swipe: partial enters the pharmacy is a group of people often get wrapped drugs, outside the check-out swipe the cashier according to bag paste the label of the input types, but don't check bags medicine, should pay cash is no charge. Ascertained that, after this is done through empty brush medicare card, diddle series as a whole of fund of medical treatment insurance fraud. In the end, several suspects was sentenced for fraud. (on March 9, the modern express)
 
    The case can be solved, because the social security fund center staff have high vigilance, install this oversight measures to control also benefit from the pharmacy. Therefore, only from the point of view of the case, suzhou city, the center of the social security fund is commendable. At the same time, the case for investigation is accidental. If this batch of "extras" acting is better, if the cashier check the drug according to common practice, and charge should pay cash after getting the chance to return again, so, see a surveillance also could not find the abnormal. And after the exposure, if someone will obtain the behavior of the medical insurance fund designed to be more fine, participate in the insurance fraud is acting more "professional", is similar to the insurance fraud behavior, it can be difficult to be found.
 
    Obviously, verify health care fraud can not only see the "acting", should be based on the plug hole. Some policies and regulations, is to the specific group of care, but also provoke to cheat. Such as the local medical insurance card accounts including foundation fund of medical treatment at gold and complementary, basic medical gold after use, ginseng protect people pays 600 yuan, can produce 2500 yuan fund, personal pay only 40% of 2500 yuan, will the remaining 60% subsidy to a pharmacy. But it is 2500 yuan, as well as patients with emergencies, and makes the individual outlaw perform the bad state of mind. If recognize deception can only rely on monitoring, so, this $2500 is destined to be a thief.
 
    Ensure the safety of medical insurance fund should be more reasonable and more detailed, with 2500 yuan added fund, for example, patients who receive the fund, its prevalence and treatment process, should be included in the health monitoring, should at least after the audit, if so, even if a liar deception again good, the doctor also can't do reasonable consumption, health care workers through this way to find problems, diddle compensatory fund behavior, can not escape the French open.
 
    In fact, diddle added funds are just one of all kinds of medical insurance deception, to medicare funds more secure, can never count on accidental discovery, need wove medical insurance fund supervision and audit of seamless network, so to verify all kinds of insurance fraud behavior inevitably.