我国医疗保险欺诈现状及管控对策研究  

Research on the current situation of medical insurance fraud in China and Its Control Countermeasures

作　　者：周娟[1,2] 肖军[1,2] Zhou Juan;Xiao Jun(College of Criminal Investigation,Southwest University of Political Science and Law,Chongqing 401120,China;Insurance fraud research center of Southwest University of Political Science and Law,Chongqing 401120,China)

机构地区：[1]西南政法大学刑事侦查学院,重庆401120 [2]西南政法大学保险欺诈研究中心,重庆401120

出　　处：《中国卫生法制》2022年第4期48-51,43,共5页China Health Law

摘　　要：我国医疗保险欺诈现象由来已久,在医保治理中已经成为难以去除的沉疴顽疾。随着新闻媒体不断曝光医保欺诈事件,医保欺诈问题逐渐成为民众关心的舆论焦点。基于对我国医保欺诈的现状及稽查困难的原因进行分析,提出通过完善相关的法律规制、构建多部门联动机制、加强队伍能力和技术建设、弘扬医保诚信风气,更好地对其进行监管和刑事打击与反制,维护医保基金的安全及其正常运行。The phenomenon of medical insurance fraud has a long history in China, and it has become a stubborn disease in medical insurance governance. In recent years, with the continuous exposure of medical insurance fraud by the news media, medical insurance fraud has gradually become the focus of public opinion. Based on the analysis of the current situation of medical insurance fraud in China and the reasons of the difficulties in its inspection, this paper put forward some suggestions through improving the relevant legal regulations we should build a multi department linkage mechanism, strengthen the team capacity and technology construction, carry forward the integrity of medical insurance, better supervise and criminal attack and countermeasures, and maintain the safety and normal operation of medical insurance fund.

关 键 词：医保欺诈 稽查困难 管控对策 法律规制 大数据侦查 

分 类 号：D902[政治法律—法学理论]