医药反腐背景下医药机构医保诈骗犯罪实证研究
An Empirical Study on the Crime of Medical Insurance Fraud in Medical Institutions under the Background of Medical Anti-corruption
张文英 1曾小燕2
作者信息
- 1. 福州工商学院文法学院 福州 350001
- 2. 遂川县人民法院 江西 吉安市 343900
- 折叠
摘要
医药领域反腐集中整治活动,暴露出医药机构的利益勾连是医保诈骗犯罪的一颗毒瘤.通过对医保诈骗犯罪的实证分析,发现近几年的医保诈骗犯罪呈现以下新特点:犯罪方法更隐蔽、单位犯罪激增、发案领域较为集中.将医保诈骗犯罪的预控研究集中在医药机构的监管上,建立各部门联动办案机制、医保智能监督系统、特殊病种核查机制,加大对信息健康领域的数字化转型,利用科技手段预防医保诈骗犯罪.
Abstract
The centralized anti-corruption rectification activities in the medical field reveal that the interest linkage of medical institutions is like a huge tumor of medical insurance fraud.Through the empirical analysis of the medical insurance fraud crime,it is found that the medical insurance fraud crime in recent years presents the following new characteristics:the crime method is more concealed,the unit crime is increasing sharply,and the crime-prone field is more concentrated.We focus the research on the pre-control of medical insurance fraud crime on the supervision of medical institutions,establish a mechanism for handling cases in coordination with various departments,an intelligent medical insurance supervision system,and a verification mechanism for special diseases,increase the digital transformation in the field of information health,and use scientific and technological means to prevent medical insurance fraud crimes.
关键词
医保诈骗/医药机构/智能监管Key words
Medical insurance fraud/Medical institutions/Intelligent supervision引用本文复制引用
出版年
2024
NETL
NSTL
万方数据