温州建立纵向联动横向协同医保稽核机制  

Explore New Forms of Medical Insurance Audit in Wenzhou

作　　者：竺小方 林煦 徐群 林晓冰 曹玮 林峰 

机构地区：[1]浙江省温州市医保中心,温州325000 [2]浙江省瑞安市人力资源和社会保障局,瑞安325200 [3]浙江省温州市人力资源和社会保障局,温州325000 [4]浙江省温州市鹿城区人力资源和社会保障局,温州325000

出　　处：《中国医疗保险》2015年第7期36-38,共3页China Health Insurance

摘　　要：医疗保险欺诈骗保呈现出主体多样、手法多变、骗保数额越来越大、情节越来越恶劣,甚至出现跨地区"一条龙制造假发票"现象,给医疗保险反欺诈的稽核工作带来挑战。温州市采取的系统内联动稽核、跨部门协同稽核举措取得良好效果,但仍存在缺人手、缺法律支撑等难题,亟待加强稽核队伍的专业化建设。The cheating and fraudulent behaviors in medical insurance presents characteristics of subjects diversity, methods variety, amount growth and situation worsening, and even there are systematic procedures making false invoices, which challenge greatly the anti-fraud audit work in medical insurance. By taking intra-system, and trans-department coordinately auditing in Wenzhou, a good effect has been achieved. However, there are still problems of short manpower and lack of legal support. The construction of audit professional team should also be intensified.

关 键 词：医疗保险 违规 欺诈 稽核 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]