福建厦门是全国较早实现全民医保的城市，在医保惠及越来越多群众的同时，也对医保基金的监管带来了压力。医保骗保手法已从早期的以药品换物品，发展到医院药店勾结、门诊假冒住院“空刷”医保卡等多种手法，并呈现作案组织化、利益链条化苗头。

Xiamen, fujian province is the earlier achieve universal coverage of the city,In the medical insurance benefit more and more people at the same time,Also to the supervision of the medical insurance fund pressure.Medical insurance cheat the technique already from early to drugs in items,The development of hospital pharmacy collusion/Hospital outpatient fake"Air brush"Medical insurance card and so on many kinds of techniques,And present the crime organization/Interests chain change symptom.

　　骗保手法花样百出 Cheat the technique pattern

　　记者采访了解到，近年来，骗取医保基金的手法不断翻新，不少药店经营者同时开设门诊部或与某些医疗机构勾结骗取医保基金。厦门市查处的万善堂药店就是一个典型案例。据了解，该药店负责人李某每隔两三天就将万善堂药店收取的医保卡送到德丰堂门诊部刷卡后拿回，店里则备有生活用品、保健滋补品供医保参保人用于“套刷”。该店要求营业员发展“客源”盗刷医保卡以完成门诊部“外刷”的营业额，并从中抽取一定的比例分红。后续调查了解到，万善堂药店和德丰堂门诊部的老板是同一人。

Reporters learned,In recent years,The technique of the medical insurance fund swindle unceasingly,A lot of pharmacy operators at the same time open clinic or with some medical institutions collusion diddle medical insurance fund.Xiamen and WanShanTang pharmacy is a typical case.It is understood,The pharmacy chief li mou every two or three days will WanShanTang pharmacy charge insurane card to DE FengTang clinic after credit card back,The store is equipped with articles for daily use/Health tonic for medical insurance protects a person used to"Brush sets".The shop assistant development requirements"tourists"Medical insurance card stolen brush to complete the clinic"Outside brush"turnover,To extract certain proportion share out bonus.The follow-up survey to understand,WanShanTang pharmacies and DE FengTang clinic boss is the same person.

　　厦门市查处的集美东南医院涉嫌合同诈骗案，则创下了全市骗取医保基金的最高纪录，目前已查明该院骗取医保基金496.6万元人民币，涉及的参保人员达数千人。2009年1月至2011年4月间，集美东南医院出资人、实际控制人苏某和该院院长张某组织人员大肆宣扬“看病不花钱”、免收患者自付段费用等，以此手段招揽参保人员到该院看病，采用“小病大治”的方式，由医院医生给参保人员办理“假住院”骗取医保基金。

Xiamen jimei and southeast hospital suspected of contract fraud,Is a swindle the medical insurance fund of the record,At present already find out the hospital diddle medical insurance fund is 4.966 million yuan RMB,Involved in the ginseng protect personnel to thousands of people.January 2009 to April,Jimei southeast hospital contributor/Actual controller SuMou and hospital director zhang organization personnel whoop it up"The doctor not to spend money"/From patients since the pay period of expenses, etc,This means solicit ginseng protect personnel to the hospital to see a doctor,the"Ailment great order"way,The hospital doctors to ginseng protect personnel to deal with"False in hospital"Diddle medical insurance fund.

　　一些不法分子甚至在没有发生医疗服务行为的情况下“空刷”社保卡。厦门市有关人士透露，现在诈骗医保基金已从以往的刷非医保药、刷保健品、生活用品等“套刷”阶段，向伪造医疗服务项目“空刷”医保卡发展。但苦于参与作案的参保人不配合，执法人员很难查实。

Some lawless elements even in did not happen under the condition of medical service behavior"Air brush"Social security card.Xiamen officials revealed,Now the medical insurance fund has fraud from past brush not health care medicine/Brush health products/Articles for daily use, etc"Brush sets"stage,To forge medical services"Air brush"Medical insurance card development.But it is involved in the crime ginseng protect people don't fit,Law enforcement personnel it is difficult to verify.

　　“不拿白不拿”思想助长骗保歪风 "Don't take white don't take"Thought encourage cheat the unhealthy tendency

　　厦门秋生律师事务所律师杨毅表示，医保基金的监管是个世界性难题，我国也不例外。在国内目前最突出的问题是个别群众思想认识不到位，对骗取医保基金行为的危害性和严重性认识不足。

Xiamen Anthony wong law firm's lawyers, Yang yi, said,The medical insurance fund supervision is a worldwide problem,Our country is no exception.In China the most prominent problem is the individual thinking does not reach the designated position,The medical insurance fund to swindle the harm of the action and seriousness, inadequate understanding.

　　记者采访了解到，不少人将医保基金视为“政府福利”，即使没买药看病也要想方设法将钱弄出来，存在“不拿白不拿”的思想，对骗保行为的严重后果认识不足。一些医保工作人员表示，随着医保覆盖面的不断扩大，医保基金的监管面临着新的挑战。一个突出的问题是，相对于在职职工，其他参保人群没有个人账户，这些人看病买药有个自付比例，而报销部分全部从统筹基金的“大锅”中支出。一些参保群众自觉或不自觉配合医疗服务机构，参与骗取、套取医保基金。

Reporters learned,Many people will be regarded as the medical insurance fund"The government welfare",Even if didn't buy medicine to see a doctor to also want to try to put the money out,exist"Don't take white don't take"thoughts,To cheat the behavior of the serious consequences, inadequate understanding.Some medical researchers say,With the constant enlargement of the medical insurance coverage,The supervision of the medical insurance fund faces new challenges.A prominent problem is,Relative to on-the-job worker,Other ginseng protect people have no personal account,These people see a doctor to buy medicine has a self pay scale,And to submit an expense account from all parts of the plan as a whole fund"cauldron"Spending in.Some ginseng protect people consciously or unconsciously with medical services,Involved in cheating/Show the medical insurance fund.

　　违法成本低打击难 The illegal cost low hit hard

　　目前我国针对社保资金监管的法律主要是《中华人民共和国社会保险法》，该法规定，对于骗取社保基金的“责令退回骗取的社会保险金，处骗取金额二倍以上五倍以下的罚款。”厦门市近年来查处的医保骗保案件，也多以罚款来处理。而对涉及骗保案件的普通参保人，更只能罚款了事。

At present our country according to the social security fund supervision law mainly[Social insurance law of the People's Republic of China],The law,The social security fund to cheat"The social insurance amount shall be ordered to return swindle,Place the amount of diddle twice to less than five times the fine."In recent years the xiamen and medical insurance PianBaoAn parts,Also with a fine to deal with.And for those involved in the PianBaoAn a common ginseng protect people,Only a more fine.

　　目前我国刑法中“保险诈骗罪”针对的是商业保险，个人进行保险诈骗数额在一万元以上的属于“数额较大”，单位进行保险诈骗数额在五万元以上属于“数额较大”，处五年以下有期徒刑或者拘役，并处一万元以上10万元以下罚金。厦门市人力资源和社会保障局一位工作人员说，目前国家法律对医保基金的保护力度，竟还赶不上对商业保险金的保护力度。

At present in China's criminal law"Insurance fraud"In the commercial insurance,Personal insurance fraud in the amount of ten thousand yuan to belong to"Large amount",Units for the amount of insurance fraud in fifty thousand yuan of above belong to"Large amount",Place five years imprisonment or criminal detention,Less than ten thousand yuan of above 100000 yuan of the following fine.Xiamen human resources and social security bureau a staff said,At present the country laws on the protection of the medical insurance fund strength,But still miss to commercial insurance protection efforts.

　　厦门市社保中心相关人士介绍，目前医保定点服务机构与医保管理部门之间是合同协议管理关系，因此骗取医保基金也多以合同诈骗罪来追究。在厦门市集美东南医院案件中，骗取医保基金达496万元之巨，涉及数千参保人，可谓数额巨大、情节恶劣，但最终也是依涉嫌合同诈骗来追究法律责任，处罚尺度也相较保险诈骗罪轻微。

Relevant personage introduces xiamen social security center,Current health care point service agencies and the medical insurance management department is the contract agreement between relationship management,So the medical insurance fund also cheat in the crime of fraud of the contract shall come.In xiamen jimei southeast hospital cases,Diddle medical insurance fund of 4.96 million yuan of the giant,Involving thousands of ginseng protect people,Amount is huge/Plot bad,But in the end is also suspected of fraud in accordance with the contract to shall be investigated for legal responsibility,Punishment scale than slight insurance fraud.

　　《中华人民共和国社会保险法》规定“违反本法规定，构成犯罪的，依法追究刑事责任。”不少人士反映，该法对骗取医保基金犯罪行为的处罚规定过于笼统，给基层办案带来困惑。

[Social insurance law of the People's Republic of China]provisions", in violation of the provisions of,Constitute a crime,Shall be investigated for criminal responsibility according to law."Many people reflect,The medical insurance fund to swindle crime penalty provision is too general,To base courses bring confusion.

　　杨毅表示，到了什么程度要立案，定什么罪、如何量刑，《中华人民共和国社会保险法》都没有予以明确规定，这首先给基层公安部门立案带来困难。如果像“保险诈骗罪”明确规定诈骗金额达到一万元就属“数额较大”，相信医保诈骗被立案追究刑责的将大大增加，以身试法者将大大减少。（项开来）

, Yang yi, said,To what extent will put on record,What sin shall/To what extent,[Social insurance law of the People's Republic of China]Are not to be specified,The first basic public security department to put on record difficult.If like"Insurance fraud"Specific provision fraud belongs to the amount of ten thousand yuan"Large amount",Believe that medical insurance fraud is put on record of the responsibility shall be investigated for punishment will greatly increase,Who defy the law will be greatly reduced.(Item from)