医疗费用医保结算诈骗原因分析与预防

Legal construction of medical insurance:resolution of fraud risk in medical insurance expense settlement

医疗保险涉及到广大人民群众的切身利益。但是近些年随着我国城乡统筹医疗保险的覆盖范围急剧扩大,定点医疗结构的数量迅速增多,医疗保险医疗费用结算欺诈行为也日益增多,严重影响了我国医疗保险事业的健康稳定发展。采用案例分析的形式,首先对案例基本情况进行介绍,在此基础上重点分析案例带给我们的启示以及医疗保险费用结算欺诈风险化解对策。

Medical insurance involves the vital interests of the broad masses of the people.However,in recent years,with the rapid expansion of the coverage of urban and rural medical insurance,the number of medical insurance designated hospitals has increased rapidly,and the fraudulent settlement of medical expenses has also increased,which has seriously affected the healthy and stable development of medical insurance in China.Based on this,this paper used the form of case analysis,first introduced the basic situation of the case,and then focused on the analysis of the enlightenment brought by the case and the countermeasures to resolve the fraud risk in the settlement of medical insurance costs.