33起医疗机构套取医疗保险基金犯罪案件的分析与思考

Research on 33 crimes of illegal obtaining medical insurance fund

目的:探索针对性措施,防范套取医疗保险基金犯罪。方法:到中国裁判文书官方网站搜索关键词“套取医保基金”和“刑事案件”,共获得2007-2018年全国套取医疗保险基金犯罪裁判文书33份。将33份裁判文书数据录入Excel2007进行统计分析。结果:2007-2018年全国33起套取医疗保险基金案件共套取医保基金70 296 385.10元,涉及13个省份、8类33家医疗机构、6种手段、4类刑事案件和155名罪犯。结论:犯罪数据在各类分组中各有特点,民营医疗机构案件频发,诈骗犯罪所占比重最大。

Objective: To explore the directed measures to prevent the occurrence of illegal obtaining medical insurance fund. Methods: The cases of crime from 2007 to 2018 were retrieved by search of the keywords of “illegal obtaining medical insurance fund” and “criminal case” from the official website of China Judicial Documents. A total of 33 copies of judgment documents were obtained. The data of all the cases was entered with Excel 2007 for the further statistical analysis. Results: The loss amount of 33 cases reached 70,296,385.10 yuan. They also involved 13 provinces, 8 types of 33 medical institutions, 6 deceptions, 4 kinds of criminal case and 155 criminals. Conclusions: The criminal data showed different characteristics in all kind of categories. The higher crime frequency occurred in private medical institutions. Fraud crime accounted for the largest proportion in the cases.