论文部分内容阅读
近年来,随着医疗保险制度改革的深入,参保人员的医保待遇逐步提高了,但同时,违规使用医保基金的情况也越来越复杂。由于医保政策原则性强而医疗行为的实施弹性较大,一些情况下难以明确界定医疗过度或违规,有些违规行为甚至因跨行业跨部门而难以处理。目前,违规使用医保基金的手段主要有诱骗、伪造、套现、串通几种。
In recent years, with the deepening of the reform of the medical insurance system, the medical insurance for insured persons has gradually increased, but at the same time, the illegal use of medical insurance funds has become more and more complicated. Due to the strong principle of medical insurance policy and the great flexibility in the implementation of medical practices, it is difficult to clearly define medical over or irregularities in some cases. Some of the irregularities are even difficult to handle because of cross-sectoral and cross-sectoral work. At present, the main means of illegal use of Medicare funds are trickery, counterfeiting, cashing out and collusion.