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医保骗保行为特征分析与敏捷预防治理策略研究

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随着医保领域打击欺诈骗保力度的加大,医保骗保行为呈现出实施主体多元、手段专业多样、行为隐蔽复杂、社会危害加重等特征,导致医保基金监管难度加大,存在打击欺诈骗保取证侦查难、追赃挽损难、多环节复杂主体打击难等问题.为破解这些难点,更好地维护基金使用安全,本文从多主体协同治理与风险预防为核心的敏捷预防治理理论着手,构建多主体协同预防治理模式,以期促进医保基金持久稳健运行.
Analysis of Characteristics of Medical Insurance Fraud Behavior and Research on the Agile Prevention and Governance Strategies
With the increasing efforts to crack down on medical insurance fraud in the medical insurance field,the behavior of medical insurance fraud presents characteristics such as diverse implementation subjects,various professional methods,hidden and complex behaviors,and increased social harm,resulting in the increased difficulty of regulating medical insurance fund. There are many problems,such as difficulties in evidence collection and investigation,difficulties in recovering stolen goods and losses,and difficulties in cracking down on complex entities in multiple links. In order to solve the problems and further maintain the medical insurance fund security,this paper starts with the agile prevention and governance theory with multi-agent collaborative governance and risk prevention as the core,constructs a multi-subject collaborative prevention and governance model,to promote the sustainable and stable operation of the medical insurance fund.

medical insurance fraudsituational preventionagile preventioncollaborative governance

林仕敏

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云南大学法学院 昆明 650504

医保骗保 情境预防 敏捷预防 协同治理

2024

中国医疗保险
中国医疗保险研究会

中国医疗保险

影响因子:0.492
ISSN:1674-3830
年,卷(期):2024.(12)