曝光台！寻乌一药房涉骗取医保基金案，罚款2万余元！
<div class="wx_rich_media_content" id="jsWxContainer"><section style='line-height: normal;'><br></section><p><br></p><section data-role="outer" label="Powered by 135editor.com" style='max-width: 100%; box-sizing: border-box !important;'><section data-tools="135编辑器" data-id="87704" data-color="#fcb42b" data-custom="#fcb42b" style='max-width: 100%; box-sizing: border-box !important;'><section style='max-width: 100%; box-sizing: border-box !important;'><section style='margin: 15px 6px; padding: 1em; max-width: 100%; box-sizing: border-box; box-shadow: rgb(165, 165, 165) 0px 0px 12.8px 0px; overflow: hidden;'><section style='padding: 0.1em 0.1em 0em; max-width: 100%; display: inline-block; text-align: center; color: rgb(255, 255, 255); background: rgb(252, 180, 43); transform: rotate(0deg); box-sizing: border-box !important;'><section data-bcless="darken" data-bclessp="20%" data-width="90%" style='margin-top: -0.2em; margin-left: -1px; max-width: 100%; width: 79px; height: 1px; border-top: 0.3em solid rgb(190, 126, 3); border-right-color: rgb(190, 126, 3); border-bottom-color: rgb(190, 126, 3); border-left-color: rgb(190, 126, 3); overflow: hidden; box-sizing: border-box !important; transform: rotate(-3deg) !important;'><br style='max-width: 100%; box-sizing: border-box !important;'></section><section style='padding: 0.5em 0.8em; max-width: 100%; box-sizing: border-box;'><p style='max-width: 100%; min-height: 1em; box-sizing: border-box !important;'><strong><span style='max-width: 100%; font-size: 15px; box-sizing: border-box !important;'>以案释法</span></strong><span style='max-width: 100%; font-size: 15px; box-sizing: border-box !important;'></span></p></section></section><section style='margin-top: -1em; margin-right: auto; margin-left: auto; padding-top: 1em; padding-right: 0.5em; padding-left: 0.5em; max-width: 100%; box-sizing: border-box; width: auto; height: auto; overflow: hidden; border-top: 0.1em dashed rgb(252, 180, 43); line-height: 1.4em;'><section style='padding-top: 10px; padding-bottom: 10px; max-width: 100%; box-sizing: border-box;'><p style='margin-top: 20px; max-width: 100%; min-height: 1em; text-align: center; line-height: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 169, 0); font-size: 18px; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'>赣州市曝光2019年度打击欺诈骗保</strong></span></p><p style='margin-top: 5px; max-width: 100%; min-height: 1em; text-align: center; line-height: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 169, 0); font-size: 18px; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'>十起典型案例</strong></span></p><section style='max-width: 100%; line-height: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(0, 0, 0); font-size: 15px; box-sizing: border-box !important;'></span><p style='margin-top: 15px; max-width: 100%; min-height: 1em; line-height: 40px; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>去年的打击欺诈骗保专项治理工作中，全市医疗保障部门依法查处了一批欺诈骗取医保基金案例，为进一步展示医疗保障部门维护医保基金安全的信心、决心，形成对欺诈骗保行为的有效震慑，现将第一批汇总的10个典型案例进行曝光。</span></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-align: center; line-height: 40px; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例1：全南邦友大药房骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-indent: 43px; line-height: 40px; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，全南邦友大药房存在为非定点零售药店提供医保服务及费用结算的问题，违规套取医保基金33342.40元。根据《中华人民共和国社会保险法》和医保服务协议等相关规定。全南县医疗保障局于2019年6月15日做出解除该药店医保定点服务协议、追回违规医保基金33342.40元的处理决定。</span></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-align: center; line-height: 40px; text-indent: 0em; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例2：赣州市香洋大药房骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; line-height: 35px; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，赣州市香洋大药房存在摆放日用品、串换药品及销售记录和医保数据不符等问题，违规套取医保基金36731.90元，根据《社会保险法》和医保服务协议等相关规定。赣州蓉江新区人力资源和社会保障局于2019年6月5日做出暂停该药店医保定点服务协议三个月、追回违规医保基金36731.90元的处理决定。</span></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-align: center; line-height: 40px; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例3：</span></strong><strong style='max-width: 100%; text-indent: 43px; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>瑞金康民中医院骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; line-height: 40px; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，瑞金康民中医院存在挂床住院、多收费、串换医保项目、使用医保限制性用药进行报销等问题，违规套取医保基金118399.41元，根据《社会保险法》和医保服务协议等相关规定。瑞金市医疗保障局于2019年11月27日做出责令该院立即整改、追回违规医保基金118399.41元、行政罚款236798.82元的处理决定。</span></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-align: center; line-height: 40px; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例4：</span></strong><strong style='max-width: 100%; text-indent: 43px; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>寻乌县地康大药房骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-indent: 43px; line-height: 40px; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，寻乌县地康大药房存在摆放日用品、食品及违规串换药品等问题，违规套取医保基金1.06万元。根据《社会保险法》和医保定点机构服务协议等相关规定进行了处罚。寻乌县医疗保障局于2019年12月19日做出追回违规医保基金1.06万元、行政罚款2.12万元的处理决定。</span></p><p style='margin-top: 15px; margin-bottom: 8px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例5：</span></strong><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>上犹县油石乡中心卫生院</span></strong><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，上犹县油石乡中心卫生院存在低门槛入院、套餐式检查（无适应症检查)、部分医保目录匹配不准确（丙、乙类项目串换成甲类）等问题，违规套取医保基金4653.04元。根据《社会保险法》和医保服务协议等相关规定。上犹县医疗保障局于2019年12月1日做出追回违规医保基金4653.04元、行政处罚9306.08元的处理决定。</span></p><p style='margin-top: 15px; margin-bottom: 8px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例6：信丰县新田镇花历村卫生室骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; line-height: 40px; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，信丰县新田镇花历村卫生室存在无诊疗行为售药、不提供购药小票现象、未按相关规定留底门诊处方笺、滞留医保卡等问题。2018年至2019年间，违规套取医保基金19288.00元。根据《社会保险法》和医保服务协议等相关规定。信丰县医疗保障局于2019年7月19日做出通报该卫生室违规行为、追回违规医保基金19288.00元的处理决定。</span></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例7：</span></strong><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>赣州昌隆医院骗取医保基金案</span></strong><br style='max-width: 100%; box-sizing: border-box !important;'></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; line-height: 40px; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，赣州昌隆医院存在放宽入院指征、过度检查、中医理疗过度治疗、无治疗收费、超标准收费、中医理理疗无明细收费以及篡改手术记录等问题。违规套取医保基金54633.49元。根据《社会保险法》和医保服务协议等相关规定。赣州经开区医疗保险事业管理局于2019年10月23日做出暂停该院医保定点服务协议三个月并对该院的法人和院长进行约谈、追回违规医保基金54633.49元的处理决定。</span></p><p style='margin-top: 15px; margin-bottom: 8px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例8：</span></strong><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>兴国县康复医院骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-indent: 42px; line-height: 40px; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，兴国县康复医院存在挂床住院、不合理治疗、过度检查、限制性用药、不合理收费等问题，违规套取医保基金93645.48元。根据《社会保险法》和医保服务协议等相关规定。兴国县医疗保障局于2019年12月16日做出责令该院限期整改，追回违规医保基金93645.48元的处理决定。</span></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-align: center; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例9：</span></strong><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>安远县骗取医保基金待遇典型案例</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，安远县某乡卫生院职工肖某某在值班期间受伤，故意隐瞒其受伤原因进行医疗统筹报销，拿到《工伤认定决定书》后，仍未向安远县医医疗保障局如实反映情况并退还医疗统筹报销费用问题，违规套取医保基金16456.43元。依据《中华人民共和国社会保险法》第三十条规定。安远县医疗保障局于2019年12月27日做出对该参保人骗取医保基金行为给予警示教育并在全县通报曝光、追回违规医保基金16456.43元等处理决定。</span></p><p style='margin-top: 20px; max-width: 100%; min-height: 1em; text-align: center; text-indent: 0em; box-sizing: border-box !important;'><strong style='max-width: 100%; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>案例10：</span></strong><strong style='max-width: 100%; text-align: justify; box-sizing: border-box !important;'><span style='max-width: 100%; color: rgb(255, 0, 0); font-family: 宋体, SimSun; box-sizing: border-box !important;'>宁都县康泰大药房胜利店骗取医保基金案</span></strong></p><p style='margin-top: 15px; max-width: 100%; min-height: 1em; text-indent: 2em; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体, SimSun; box-sizing: border-box !important;'>经查，宁都县康泰大药房胜利店存在进销存不符、串换药品等问题，违规套取医保基金13248.50元。根据《社会保险法》和医保服务协议等相关规定。宁都县医疗保障局于2019年12月30日做出追回违规医保基金13248.50元的处理决定。</span></p></section></section></section></section></section></section></section><section data-role="paragraph"><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='color: #ff0000;'><strong><span style='max-width: 100%; font-size: 15px; font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>每年4月，</span></strong></span></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='color: #ff0000;'><strong><span style='max-width: 100%; font-size: 15px; font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>全国都会统一开展打击欺诈骗保</span></strong></span></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='color: #ff0000;'><strong><span style='max-width: 100%; font-size: 15px; font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>维护基金安全集中宣传月活动。</span></strong></span></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='color: #ff0000;'><strong><span style='max-width: 100%; font-size: 15px; font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>打击欺诈骗取医保基金行为，</span></strong></span></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='color: #ff0000;'><strong><span style='max-width: 100%; font-size: 15px; font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>这些知识你知道吗？</span></strong></span></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><br></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span class="wxart_image" wx-style='display:inline-block;width: 236px;height: 225px;'></span></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'></span></p><section data-tools="135编辑器" data-id="98010"><section style='margin: 10px auto;text-align: center;'><section style='width: 100%;' data-width="100%"><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);background: rgb(243, 68, 85);color: rgb(255, 255, 255);box-sizing: border-box;'><section style='height: 30px;display: flex;justify-content: center;align-items: center;'><section data-brushtype="text" style='padding: 4px 1em;font-size: 14px;letter-spacing: 1.5px;box-sizing: border-box;'>一</section><section data-brushtype="text" style='background: rgb(255, 255, 255);color: rgb(255, 25, 47);letter-spacing: 1.5px;font-size: 14px;line-height: 30px;padding-right: 0.5em;padding-left: 0.5em;flex: 1 1 0%;'><strong>为什么要打击欺诈骗取医保基金的行为？</strong></section></section></section><section style='display: flex;justify-content: flex-start;align-items: center;margin-left: 22px;'><section style='width: 0px;height: 1px;border-bottom: 5px solid transparent;border-right: 5px solid rgb(248, 42, 61);overflow: hidden;box-sizing: border-box;'><br></section><section style='width: 0px;height: 1px;border-bottom: 5px solid transparent;border-left: 5px solid rgb(248, 42, 61);overflow: hidden;box-sizing: border-box;'><br></section></section></section><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);box-sizing: border-box;padding: 1em;margin-top: 8px;'><section data-autoskip="1" style='font-size: 14px;text-align: justify;letter-spacing: 1.5px;line-height: 1.75em;'><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>医保基金是老百姓的“救命钱”，具有“专款专用”的性质，将医保基金视作“唐僧肉”而发生的欺诈骗取行为，最终损害的将是每一个参保人的切身利益。</span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>守护医保基金安全，促进基金有效使用，人人有责。近年来，欺诈骗取医保基金的行为多发频发，严重损害基金安全，损害广大参保人切身利益，必须坚决予以打击。</span></p></section></section></section></section><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'></span></p><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><br></p><section data-tools="135编辑器" data-id="98010"><section style='margin: 10px auto;text-align: center;'><section style='width: 100%;' data-width="100%"><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);background: rgb(243, 68, 85);color: rgb(255, 255, 255);box-sizing: border-box;'><section style='height: 30px;display: flex;justify-content: center;align-items: center;'><section data-brushtype="text" style='padding: 4px 1em;font-size: 14px;letter-spacing: 1.5px;box-sizing: border-box;'>二</section><section data-brushtype="text" style='background: rgb(255, 255, 255);color: rgb(255, 25, 47);letter-spacing: 1.5px;font-size: 14px;line-height: 30px;padding-right: 0.5em;padding-left: 0.5em;flex: 1 1 0%;'><strong>涉及定点医疗机构的欺诈骗保行为有哪些？</strong></section></section></section><section style='display: flex;justify-content: flex-start;align-items: center;margin-left: 22px;'><section style='width: 0px;height: 1px;border-bottom: 5px solid transparent;border-right: 5px solid #f82a3d;overflow: hidden;box-sizing: border-box;'><br></section></section></section><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);box-sizing: border-box;padding: 1em;margin-top: 8px;'><section data-autoskip="1" style='font-size: 14px;text-align: justify;letter-spacing: 1.5px;line-height: 1.75em;'><p style='max-width: 100%; min-height: 1em; font-family: -apple-system-font, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; letter-spacing: 0.483556px; text-indent: 32px; text-align: left; line-height: 24px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; box-sizing: border-box !important;'><span style='max-width: 100%; font-family: 宋体; color: rgb(47, 47, 47); letter-spacing: 0px; font-size: 17px; box-sizing: border-box !important;'><br></span></p><p style='max-width: 100%; min-height: 1em; font-family: -apple-system-font, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; letter-spacing: 0.483556px; box-sizing: border-box !important;'>MzA5NTMzNjA4Mw==||2660684532||wxv_1297671965993484290</p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>1.虚构医药服务，伪造医疗文书和票据，骗取医保基金的；</span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>2.为参保人员提供虚假发票的；</span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>3.将应由个人负担的医疗费用记入医疗保障基金支付范围的；</span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>4.为不属于医保范围的人员办理医保待遇的；</span></p><p style='max-width: 100%; min-height: 1em; font-family: -apple-system-font, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; letter-spacing: 0.483556px; box-sizing: border-box !important;'>MzA5NTMzNjA4Mw==||2660684532||wxv_1297671965993484290</p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><br></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>5.为非定点医药机构提供刷卡记账服务的；</span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>6.挂名住院的；</span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>7.串换药品、耗材、物品、诊疗项目等骗取医保基金支出的。</span></p><p style='text-align: center; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span class="wxart_image" wx-style='display:inline-block;width: 100%;box-sizing: border-box !important;overflow-wrap: break-word !important;visibility: visible !important;'></span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'></span></p></section></section></section></section><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 1.5px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><br></p><section data-tools="135编辑器" data-id="98010"><section style='margin: 10px auto;text-align: center;'><section style='width: 100%;' data-width="100%"><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);background: rgb(243, 68, 85);color: rgb(255, 255, 255);box-sizing: border-box;'><section style='height: 30px;display: flex;justify-content: center;align-items: center;'><section data-brushtype="text" style='padding: 4px 1em;font-size: 14px;letter-spacing: 1.5px;box-sizing: border-box;'>三</section><section data-brushtype="text" style='background: rgb(255, 255, 255);color: rgb(255, 25, 47);letter-spacing: 1.5px;font-size: 14px;line-height: 30px;padding-right: 0.5em;padding-left: 0.5em;flex: 1 1 0%;'><strong>涉及定点零售药店的欺诈骗保行为有哪些？</strong></section></section></section><section style='display: flex;justify-content: flex-start;align-items: center;margin-left: 22px;'><section style='width: 0px;height: 1px;border-bottom: 5px solid transparent;border-right: 5px solid rgb(248, 42, 61);overflow: hidden;box-sizing: border-box;'><br></section><section style='width: 0px;height: 1px;border-bottom: 5px solid transparent;border-left: 5px solid rgb(248, 42, 61);overflow: hidden;box-sizing: border-box;'><br></section></section></section><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);box-sizing: border-box;padding: 1em;margin-top: 8px;'><section data-autoskip="1" style='font-size: 14px;text-align: justify;letter-spacing: 1.5px;line-height: 1.75em;'><section style='max-width: 100%; letter-spacing: 0.483556px; min-height: 1em; text-indent: 2em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><p style='line-height: 1.75em;'><span style='max-width: 100%; text-align: left; text-indent: 32px; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>1.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；</span></p></section><section style='max-width: 100%; letter-spacing: 0.483556px; min-height: 1em; text-indent: 2em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><p style='line-height: 1.75em;'><span style='max-width: 100%; letter-spacing: 0px; text-align: left; text-indent: 32px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>2.为参保人员串换药品、耗材、物品等骗取医保基金支出的；</span></p></section><section style='max-width: 100%; letter-spacing: 0.483556px; min-height: 1em; text-indent: 2em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><p style='line-height: 1.75em;'><span style='max-width: 100%; letter-spacing: 0px; text-align: left; text-indent: 32px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>3.为非定点医药机构提供刷卡记账服务的；</span></p></section><section style='max-width: 100%; letter-spacing: 0.483556px; min-height: 1em; text-indent: 2em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><p style='line-height: 1.75em;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>4.为参保人员虚开发票、提供虚假发票的。</span></p></section></section></section></section></section><p style='text-align: center; max-width: 100%; min-height: 1em; font-size: 14px; letter-spacing: 0.483556px; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><br></p><section data-tools="135编辑器" data-id="98010"><section style='margin: 10px auto;text-align: center;'><section style='width: 100%;' data-width="100%"><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);background: rgb(243, 68, 85);color: rgb(255, 255, 255);box-sizing: border-box;'><section style='height: 30px;display: flex;justify-content: center;align-items: center;'><section data-brushtype="text" style='padding: 4px 1em;font-size: 14px;letter-spacing: 1.5px;box-sizing: border-box;'><span style='font-size: 15px;'><strong>四</strong></span></section><section data-brushtype="text" style='background: rgb(255, 255, 255);color: rgb(255, 25, 47);letter-spacing: 1.5px;font-size: 14px;line-height: 30px;padding-right: 0.5em;padding-left: 0.5em;flex: 1 1 0%;'><strong>涉及参保人员的哪些欺诈骗保行为可以举报呢？</strong></section></section></section><section style='display: flex;justify-content: flex-start;align-items: center;margin-left: 22px;'><section style='width: 0px;height: 1px;border-bottom: 5px solid transparent;border-right: 5px solid #f82a3d;overflow: hidden;box-sizing: border-box;'><br></section><section style='width: 0px;height: 1px;border-bottom: 5px solid transparent;border-left: 5px solid #f82a3d;overflow: hidden;box-sizing: border-box;'><br></section></section></section><section style='border-width: 1px;border-style: solid;border-color: rgb(243, 68, 85);box-sizing: border-box;padding: 1em;margin-top: 8px;'><section data-autoskip="1" style='font-size: 14px;text-align: justify;letter-spacing: 1.5px;line-height: 1.75em;'><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 32px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'></span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; line-height: 1.75em; text-indent: 0em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span class="wxart_image" wx-style='display:inline-block;width: 100%;box-sizing: border-box !important;overflow-wrap: break-word !important;visibility: visible !important;height: auto;'></span><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'></span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; text-indent: 2em; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>1.伪造假医疗服务票据，骗取医保基金的；</span></p><p style='text-align: left; max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; text-indent: 2em; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>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；</span></p><p style='max-width: 100%; min-height: 1em; letter-spacing: 0.483556px; text-indent: 2em; line-height: 1.75em; font-family: -apple-system-font, BlinkMacSystemFont, Arial, sans-serif; box-sizing: border-box !important;'><span style='max-width: 100%; letter-spacing: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-size: 15px; color: rgb(63, 63, 63); font-family: 微软雅黑, "Microsoft YaHei"; box-sizing: border-box !important;'>3.非法使用医疗保障身份凭证，套取药品耗材等，倒买倒卖非法牟利的。</span></p></section></section></section></section></section></div><p></p>
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