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国家医保局曝光台2021年第二期曝光典型案件(10例)
来源:国家医疗保障局 日期:2021-05-14 访问次数:

一、山东省淄博市精神卫生中心违规使用医保资金案

jingziboshiyibaojugenjujubaoxiansuodiaocha,faxianziboshijingshenweishengzhongxin(diwurenminyiyuan)tongguoyoudaocanbaorenguachuangzhuyuanweiguishiyongyibaozijin,sheji34269.30yuan。dangdiyibaobumenchuliruxia:1.zhuihuiziboshijingshenweishengzhongxinweiguishiyongdeyibaozijin;2.yaoqiugaiyuanxianqizhenggai;3.duigaiyuanchuyixingzhengfakuan171346.50yuan。muqian,gaiyuanweiguishiyongdeyibaozijin34269.30yuanyiquanbuzhuihui,xingzhengfakuanquanbudaozhang。

二、广东省东莞市清溪友华医院欺诈骗保案

jingdongguanshiyibaojudiaocha,faxiandongguanshiqingxiyouhuayiyuanshexiantongguo“mianfeitijian”youpiancanbaorenbanliruyuan,bingcaiquweizaoyiliaowenshu、xukaizhenliaofuwudengshouduanpianquyibaozijin,sheji139817.40yuan。dangdiyibaobumenchuliruxia:1.zhuihuiweifasuodeyibaozijin;2.jianggaianyijiaogonganbumenjinyibuchuli。muqian,qingxiyouhuayiyuanweifasuodeyibaozijin139817.40yuanquanbuzhuihui。gaianyijiaogonganhou,yiyoudongguanshidisanrenminjianchayuanxiangdangdifayuantiqigongsu,zhengzaijinyibushenlizhong。

三、黑龙江哈尔滨市双城区达康中医医院欺诈骗保案

jinghaerbinshiyibaojudiaocha,faxianhaerbinshishuangchengqudakangzhongyiyiyuanshexiantongguobianzaojiabingli、chuanhuanxiangmudengshouduanpianquyibaozijin,sheji97969.03yuan,lingfaxiangaiyuanduozhongyaopin(“zhusheyongtoubaopaitongnashubatanna”“aomeilazuozhusheye”“gutaizhusheji”deng)cunzaichaoyibaoxiandingzhifudengweiguiqingkuang,sheji72081.75yuan。dangdiyibaobumenchuliruxia:1.yijuxieyiguiding,zhuihuiweifahuodeheweiguishiyongdeyibaozijin;2.jiechushuangchengqudakangzhongyiyiyuanyibaodingdianfuwuxieyi,duiweiguixingweijinxingtongbao;3.jianggaianyijiaogonganbumenjinyibuchuli。muqian,gaiyuanweifaweiguisuodeyibaozijin170050.78yuanyiquanbuzhuihui。

四、吉林省长春市农安县鸿泰医院欺诈骗保案

jingzhangchunshinonganxianyibaojudiaocha,faxiannonganxianhongtaiyiyuanshexiantongguoweizaobinglipiaoju、xujiazhuyuan、maomingzhuyuandengshouduanpianquyibaozijin,sheji1058991.06yuan。dangdiyibaobumenchuliruxia;1.zhuihuihongtaiyiyuanweifasuodeyibaozijin;2.jiechuhongtaiyiyuanyibaodingdianfuwuxieyi;3.jianggaianyijiaogonganjinyibuchuli。muqian,gaiyuanweifasuodeyibaozijin1058991.06yuanyiquanbuzhuihui。

五、四川省泸州市泸县石桥镇卫生院违规使用医保资金案

jingluzhoushiluxianyibaojudiaocha,faxianluxianshiqiaozhenweishengyuancunzaidibiaozhunzhuyuan、wuzhizhengyongyao、chaoshiyingzhengfanweiyongyao、zhongfujiancha、taocanshijiancha、chaobiaozhunshoufeiyongdengduoxiangweiguishiyongyibaozijinxingwei,sheji345039.84yuan。dangdiyibaobumenchuliruxia:1.zhuihuiluxianshiqiaozhenweishengyuanweiguisuodeyibaozijin;2.zantinggaiyuanzhongyililiaokeyibaofuwu3geyue;3.jianggaianyijiaoluxianjiweijianweijinyibuchuli。jiweijianweijingyanjiuchuliruxia:1.yuanzhangyinmoumoushoudangneijinggaochuli;2.fuyuanzhangtangmoumoushoudangneiyanzhongjinggaochuli;3.yishengliangmoumouhexumoumoushoudangneiyanzhongjinggaochuli;4.yishengwangmoumouhexumoumoushouxingzhengjiguochuli。muqian,gaiyuanweiguisuodeyibaozijin345039.84yuanyiquanbuzhuihui。

六、浙江省台州市仙居华仁中西医结合门诊部欺诈骗保案

jingtaizhoushixianjuxianyibaojudiaocha,faxianxianjuxianxianjuhuarenzhongxiyijiehemenzhenbushexiantongguoliuyongyibaoka、maomingshiyong、xujixiangmu、chuanhuanxiangmudengshouduanpianquyibaozijin,sheji145673.18yuan。dangdiyibaobumenchuliruxia:1.zhuihuigaimenzhenbuweifasuodeyibaozijin,genjuxieyikouchuxiangyingweiyuejin;2.jiechugaimenzhenbuyibaodingdianfuwuxieyi;3.jiangcianyisonggonganbumenjinyibuchuli。muqian,gaiyuanweifasuodeyibaozijin145673.18yuanyiquanbuzhuihui,weiyuejin223648.76yuanyiquanbudaozhang。

七、湖南省岳阳市岳阳楼区居民刘某某殷某某欺诈骗保案

jingyueyangshiyueyanglouquyibaojudiaocha,faxianjuminliumoumou、yinmoumoushexiantongguoweizaoyiliaofeipiaojubaoxiaoyiliaofeiyong,fenbiepianquyibaozijin15309.39yuanhe27146.79yuan。gaianyijiaogonganhou,jinyibugudingleyouguanzhengju,quedingyishangweifashishi。jingdangdifayuanshenlipanjueruxia:1.beigaorenliumoumoufanzhapianzui,panchuyouqituxingyinian,huanxingyinianliugeyue,bingchufajin3000yuan;2.beigaorenyinmoumoufanzhapianzui,panchuyouqituxingyinianliugeyue,huanxingernian,bingchufajin3000yuan。muqian,liumoumou、yinmoumouweifasuodeyibaozijin42456.18yuanyiquanbuzhuihui。

八、山西省临汾市乡宁县参保人刘某某冒名就医案

jinglinfenshixiangningxianyibaojudiaocha,faxiancanbaorenliumoumouyu2019nian5yue30rizhi2019nian6yue16riqijianmaoyongtongcuncanbaojuminsumoumouyibaokazaixiangningxianrenminyiyuanjiuyibaoxiaoyiliaofei,sheji168270.29yuan。dangdiyibaobumenchuliruxia:1.zhuihuiliumoumouweifasuodeyibaozijin;2.genjuxieyikouchuxiangningxianrenminyiyuanweiyuejin841351.45yuan;3.zelinggaiyuanxianqizhenggai;4.jianggaianyijiaogonganbumenjinyibuchuli。muqian,liumoumouweifasuodeyibaozijin168270.29yuanyiquanbutuihui,gaiyuanweiyuejin841351.45yuanyiquanbudaozhang,dangdijijianjianchajiguanjigonganbumenyilian,zhengzaijinyibuchulizhong。

九、江苏省张家港市参保人欧某某欺诈骗保案

jingzhangjiagangshiyibaojudiaocha,faxiancanbaorenoumoumoushexiantongguopinfanzaiyabowangzhandengluduojiadingdianyiyuandaliangkaiquzhongleigudingdechufangyaopinpianquyibaozijin,sheji178032.28yuan。gaianyijiaogonganhou,jinggonganbumenjinyibudiaochagudingleyouguanzhengju,quedingyishangweifashishi。jingdangdifayuanshenlipanjueruxia:beigaorenoumoumoufanzhapianzui,panchuyouqituxingernian,huanxingsannian,bingchufajin10000yuan。muqian,gaicanbaorenweifasuodeyibaozijin178032.28yuanyiquanbuzhuihui。

十、安徽省潜山市参保人肖某某欺诈骗保案

经安徽省潜山市医保局调查,发现参保人肖某某于2018年12月10日因交通事故受伤入院治疗,获得该事故责任方支付的交通事故赔偿款之后,其子肖某涉嫌于2019年4月28日以非法占有医保资金为目的,通过故意编造隐瞒事实,虚假填报《参保人员受伤情况表》,骗取医保资金34059.50元。当地医保部门处理如下:1.追回肖某某违法所得医保资金;2.将该案移交公安部门进一步处理。目前,该参保人违法所得医保资金34059.50元已全部追回。


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