The National Health Insurance Administration announced that the first issue of 2021 exposed a typical case of a total of nine cases

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　　225　24，2021，9。、、，：

 

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　　After a joint investigation by the Jinzhou Medical Insurance Bureau and the Public Security Bureau, it was discovered that Huang Moumou, the president of Jinjing Hospital, and many people inside and outside the hospital used the medical insurance card of employees, residents, and students to apply for a false hospitalization in the medical insurance system of Jinjing Hospital, defrauding the medical insurance fund of 290,683.
15 yuan.
According to the illegal facts of the case, all the illegal funds of 290,683.
15 yuan in the case were recovered and returned to the fund account of the Medical Insurance Center.
The local court heard and decided as follows: 1.
The defendant Huang Moumou, the president of Jinjing Hospital, committed fraud and was sentenced to 8 years and 8 months in prison and fined RMB 500,000; 2.
The defendant Tian Moumou, The legal person of Jinjing Hospital committed fraud and was sentenced to 9 years’ imprisonment and fined RMB 500,000; 3.
The defendant Xu Moumou, a doctor at Jinjing Hospital, committed fraud and was sentenced to 7 years and 3 months’ imprisonment, and A fine of RMB 300,000; 4.
The defendant Duan, a financial officer of Jinjing Hospital, committed fraud and was sentenced to 5 years and 6 months in prison and a fine of RMB 250,000; 5.
The defendant Yang, An employee of Jinzhou Jiutai Pharmaceutical Co.
, Ltd.
committed fraud and was sentenced to 4 years in prison and fined RMB 150,000; 6.
The defendant Han Moumou, a teacher at Liaoning Petrochemical Vocational and Technical College, committed fraud and was sentenced to fixed-term imprisonment Three years, probation for three years, and a fine of RMB 50,000.

 

　　2.
Case of defrauding insurance from Chunwang Hospital in Wangchengpo, Changsha City, Hunan Province

 

　　After investigation by the Changsha Public Security Bureau and the Medical Insurance Bureau, it was discovered that Li XX, deputy director of Changsha Wangchengpo Chunwang Hospital, and Liu XX, the dean and legal person, fraudulently obtained medical insurance funds in terms of drugs, laboratory inspections, and Chinese medicine package treatment.
The fact of RMB 4,253,947.
38.
The persons involved in the case, Li Moumou and Zhu Moumou, have respectively returned the illegal income of RMB 2 million and RMB 100,000 to the Changsha Medical Security Affairs Center, and the remaining illegal funds of RMB 2,153,947.
38 have also been returned to the Changsha Medical Security Affairs Center.
The court verdict was as follows: Liu Moumou and Li Moumou defrauded the National Medical Insurance Fund, the amount of which was extremely large, and their actions constituted the crime of fraud.
Liu Moumou was sentenced to 10 years in prison and a fine of RMB 100,000; Li Mou was sentenced to 10 years in prison and a fine of RMB 100,000.
A certain sentenced to 3 years in prison, suspended for 5 years, and fined RMB 70,000.

 

　　3.
Case of fraud and insurance by Yikang Hospital of Traditional Chinese Medicine, Heshuo Silk Road, Heshuo County, Heshuo County, Bayingoleng, Xinjiang Uygur Autonomous Region

 

　　The Heshuo County Medical Insurance Bureau of Bayingoleng Mongolian Autonomous Prefecture conducted an investigation based on the clues of the report and found that Yang Moumou, the legal person of Heshuo Silk Road Yikang Traditional Chinese Medicine Hospital, had illegal facts such as forging medical records, lowering standard hospitalization, inflating expenses, and abusing antibiotics , Suspected of illegal use of medical insurance amount of 104,400 yuan.
After the case was transferred to the public security, Yang XX, the person involved in the case, was detained by the public security on suspicion of fraud.
All the illegal proceeds were recovered and returned to the fund account of the Medical Insurance Center.
The judgment by the local court is as follows: The defendant, Yang Moumou, a legal person from Heshuo Silk Road Yikang Traditional Chinese Medicine Hospital, committed fraud and was sentenced to three years in prison, suspended for five years, and fined RMB 100,000.

 

　　4.
The case of Zeng Moumou's fraud and insurance deception, Qiliping Town Central Hospital, Hong'an County, Huanggang City, Hubei Province

 

　　After a joint investigation by the Hong'an County Medical Insurance Bureau and the Public Security Bureau, it was discovered that Zeng Moumou, an employee of the National Medical Hall (Rehabilitation Treatment Department) of the Qiliping Town Central Hospital, was defrauded by forging medical records from August 1, 2018 to May 25, 2019.
The facts of the medical insurance fund, the illegal proceeds of the case were recovered and returned to the fund account of the medical insurance center.
The court heard the judgment: the defendant Zeng XX committed the crime of fraud.
The amount of fraud was 264,927.
12 yuan, and he was sentenced to three years and six months in prison and a fine of 100,000 yuan.

 

　　5.
Corruption case of Nian XX, former medical insurance administrator and pharmacy fee collector of Liujiaying Township Health Center, Fengrun District, Tangshan City, Hebei Province

 

　　According to the investigation by the Medical Insurance Bureau of Fengrun District, Tangshan City, Nian Mo, a medical insurance specialist and pharmacy fee collector at Liujiaying Township Health Center, was suspected of defrauding medical insurance funds by falsely reporting hospitalization information during 2018.
After the case was transferred to the public security department, the public security department further investigated and fixed relevant evidence, determined the above illegal facts, and recovered 44884.
65 yuan of illegally obtained funds.
The judgment by the local court was as follows: Defendant Nian XX was sentenced to seven months imprisonment, suspended for one year, and fined RMB 100,000 on suspicion of corruption.

 

　　6.
Case of fraud and insurance by villager Li Moumou, Bakenzhong Village, Yikenzhong Township, Ningcheng County, Chifeng City, Inner Mongolia Autonomous Region

 

　　After investigation by the Ningcheng County Medical Insurance Bureau of Chifeng City, the insured Li Moumou had used the medical insurance fund to reimburse medical expenses of 38964.
66 yuan (the expenses should not be paid by the medical insurance fund) from 2017 to 2019 by deliberately concealing the responsibility of a third party.
In fact, suspected of fraudulent insurance.
On April 2, 2020, the local court decided as follows: Defendant Li Moumou committed fraud and was sentenced to one year and 6 months imprisonment, suspended for two years, and the defendant Li Moumou’s illegal proceeds of 38964.
66 yuan were returned to the Medical Insurance Center.
Fund account, and fined RMB 5,000.

 

　　7.
Case of Zhu Moumou's fraud and insurance in Lianyungang City, Jiangsu Province

 

　　According to the investigation by the Lianyungang Medical Insurance Bureau, the insured person Bi Moumou's daughter-in-law Zhu Moumou has the joint doctor Jiang Moumou deliberately concealing the third-party liability and using the medical insurance fund to reimburse medical expenses of 22,859.
82 yuan (the cost) Should not be paid by the medical insurance fund), suspected of fraudulent insurance.
After the case was transferred to the Haizhou Public Security Bureau of Lianyungang City, it was verified that the above circumstances were true.
The judgment by the local court was as follows: the defendant Zhu XX committed fraud and was sentenced to six months in prison, suspended for one year, and fined RMB 20,000 and returned RMB 22,859.
82 to the fund account of the Medical Insurance Center.

 

　　8.
Case of insurance fraud by Yang Moumou, an insured person in Lai'an County, Chuzhou City, Anhui Province

 

　　After investigation by the Medical Insurance Bureau of Lai'an County, Chuzhou City, the insured Yang Moumou was suspected of defrauding medical expenses of 155,000 yuan by deliberately forging 3 hospital invoices to prepare medical insurance reimbursement.
After the case was transferred to the police, it was verified that the above situation was true.
The judgment by the local court is as follows: the defendant Yang XX committed fraud (attempt) and was sentenced to three years in prison, suspended for three years, and fined 20,000 yuan.

 

　　9.
The case of embezzlement of public funds by Yang from the Medical Insurance Management Center of Pu'er City, Yunnan Province

 

　　An investigation by the Pu'er Medical Insurance Bureau found that Yang Moumou, the former chief of the Financial Statistics Department of the Pu'er Medical Insurance Center, was suspected of embezzling medical insurance funds.
The clues of the case were transferred to the Pu'er Municipal Commission for Discipline Inspection and the Public Security Bureau for further investigation, the evidence was locked, all illegally obtained funds were recovered and returned to the fund account of the Medical Insurance Center.
The judgment by the local court is as follows: Yang Moumou, the former chief of the Financial Statistics Department of Pu'er Medical Insurance Center, embezzled public funds of RMB 947,836.
89, which constituted the crime of embezzling public funds and was sentenced to two years in prison and two years of probation.