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

作　　者：张文英 曾小燕 Zhang Wenying;Zeng Xiaoyan(School of Humanities and Law,Fuzhou Technology and Business University,Fuzhou 350001,China;Suichuan County People's Court,Ji'an,Jiangxi 343900,China)

机构地区：[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

出　　处：《卫生法学》2024年第5期41-46,共6页Health Law

基　　金：2023年福建省终身教育课题《老年教育机构的法律规制研究》(ZS23034)。

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。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 

分 类 号：D902[政治法律—法学理论]