摘要
目的:分析新型农村合作医疗骗保案例,为保障新型农村合作医疗基金安全运行提出策略和建议。方法:收集2007—2015年某省40个区县发生的医疗保险骗保案例,总结骗保案例的参和地区和外出就医机构分布、识别骗保的手段及其处理措施。结果:分析得出新型农村合作医疗骗保假票据的成因和在新型农村合作医疗报销过程中核查票据所遇到的问题。结论:提出了保障新型农村合作医疗基金安全运行的策略及建议。
Objective： To propose strategies and recommendations for the protection of operation of the new rural cooperative medical system（NCMS） found security, analyzed NCMS fraud cases. Methods： Basic medical insurance fraud cases were collected from 40 districts in a province and some experiences were concluded from the dimension of district from 2007 to 2015. It summarized the dis- tribution of medical institutions of anticipated regions and visiting hospitals outside the regions where had cases of insurance fraud, the methods of insurance fraud and the countermeasures. Results： Problems encountered in the process of NCMS reimbursement were ana- lyzed, and then various reasons of fraud in the reimbursement process of checking bills were summarized. Conclusion： It proposed strategies and recommendations for the protection of security operation of NCMS fund.
出处
《中国卫生经济》
北大核心
2016年第4期34-37,共4页
Chinese Health Economics
基金
国家社会科学基金课题(13CTQ032)
关键词
新型农村合作医疗
欺诈
报销
假票据
new rural cooperative medical system
fraud
reimbursement
forged bill
