2022-10-21_12-58-12.jpg
骗保
雁塔区打击欺诈骗取医疗保障基金
举报投诉电话 029-89287170
涉及参保人员的哪些行为是欺诈骗保行为？
1. 伪造假医疗服务票据，骗取医疗保障基金的；
2. 将本人的医疗保障凭证转借他人就医或持他人医疗保障凭证冒名就医的；
3. 非法使用医疗保障身份凭证，套取药品耗材等倒卖倒卖非法牟利的。
涉及定点零售药店的哪些行为是欺诈骗保行为？
1. 盗刷医疗保障身份凭证，为参保人员套取现金或购买营养保健品、化妆品、生活用品等非医疗物品的；
2. 为参保人员串换药品、耗材、物品等骗取医疗保障基金支出的；
3. 为非定点医药机构提供刷卡记账服务的；
4. 为参保人员虚开发票、提供虚假发票的。
涉及以医疗保障经办机构工作人员的哪些行为是欺诈骗保行为？
1. 为不属于医疗保障范围的人员办理医疗保障待遇手续的；
2. 违反规定支付医疗保障费用的
3. 涉及经办机构工作人员的其它欺诈骗保行为。
涉及定点医疗机构的哪些行为是欺诈骗保行为？
1. 虚构医药服务，伪造医疗文书和票据，骗取医疗保障基金的；
2. 为参保人员提供虚假发票的；
3. 将应由个人负担的医疗费用记入以医疗保障基金支付范围的；
4. 为不属于医疗保障范围的人员办理医保待遇的；
5. 为非定点医药机构提供刷卡机记账服务的
6. 挂名住院的；
7. 传唤药品、耗材、物品、诊疗项目等骗取医保基金支出的。
举报方式有哪些呢？
微信 ：关注“西安市医疗保障局“微信公众号，恢复关键字“打击骗保“或者在菜单栏内点击“了解我们”，选择“联系方式”进行举报。
写信：将举报信及相关书面资料邮寄至西安市医疗保障局或各区县医疗保障局。
电话：扫右侧二维码，拨打西安市医疗保障局打击欺诈骗取医疗保障金举报投诉电话或者各区县举报投诉电话。
西安市雁塔区医疗保障局
Insurance Fraud
Yanta District cracks down on fraudulent medical security funds
Report and Complaint Telephone 029-89287170
Which behaviours involve fraudulent insurance?
1. Forging fake medical service bills to defraud medical insurance funds;
2. Lending one’s medical insurance certificate to others for medical treatment or taking another person's medical insurance certificate to seek medical treatment under a false name;
3. Illegal use of medical insurance identity to obtain medical consumables and resell them for illegal profit.
Which behaviors involving the staff of the medical insurance agency are fraudulent insurance?
1. Going through the procedures for medical insurance benefits for persons who do not belong to the scope of medical insurance.
2. Payment of medical insurance expenses in violation of regulations
3. Other fraudulent insurance involving the staff of the agency.
Which behaviors constitute fraudulent insurance deception by designated retail pharmacies?
1. Stealing medical insurance identity, extorting cash for insured persons or purchasing non-medical items such as nutrition and health care products, cosmetics, and daily necessities;
2. Fraudulently defrauding medical insurance fund expenditures by exchanging medicines, consumables, and articles for insured;
3. Providing credit card accounting services for non-designated medical institutions;
4. Falsely invoicing or providing false invoices for the insured.
Which behaviors involving designated medical institutions are fraudulent insurance?
1. Fabricating medical services, forging medical documents and bills, and defrauding medical insurance funds;
2. Providing false invoices to the insured.
3. Record the medical expenses that should be borne by the individual into the scope of payment from the medical insurance fund;
4. Applying for medical insurance benefits for people who do not belong to the scope of medical insurance;
5. Provide credit card machine accounting services for non-designated medical institutions;
6. Those who are admitted to the hospital under a false name ;
7. Summoning medicines, consumables, items, diagnosis and treatment items to defraud medical insurance fund expenditures.
What are the ways to report?
WeChat: Follow the WeChat official account of "Xi'an Medical Security Bureau", restore the keyword "fight against insurance fraud" or click "Know Us" in the menu bar and select "Contact Information" to report.
Letter writing: Mail the report letter and related written materials to the Xi'an Municipal Medical Security Bureau or the district and county medical security bureaus.
Phone: Scan the QR code on the right, and call the report and complaint hotline of Xi'an Medical Security Bureau to combat fraud and defraud medical insurance funds or the report and complaint hotlines of various districts and counties.
Yanta District Medical Security Bureau, Xi'an
