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央视暗访北京三甲医院:号贩子没走 票贩子来了

2016-12-04 17:53:48   央视

只需一张身份证复印件和700块钱,一个连病都没看过的人摇身一变,成为了患有腰间盘突出症,经过手术后住院2周,花费近3万元,需要再休息三个月回院复诊的患者。

“新农合”骗保并非个案呈集团化趋势分工明确

没看过病,没住过院,只凭一张身份证复印件就办出来的假的看病单据,真的如票贩子所说回去就能报销吗?记者带上全套假材料,来到了四川省资阳市安岳县,当地基层医保部门的审核人员也难辨真假。700元成本,完全有可能骗取上万块的保险金。

巨大的获利空间,让不法分子盯上了“新农合”。近几年,各地也频频爆出非法套取新农合的案件。记者在四川省安岳县新农合管理中心采访时得知,当地前不久就查处了这样一起典型的案件。

今年8月,安岳县公安局成功打掉一个专门从事“新农合”医保诈骗的犯罪团伙。该团伙自2012年以来,通过虚构住院事实、伪造住院票据,先后递交240份虚假报销材料,票面金额高达上千万元。目前,该团伙41名犯罪嫌疑人已相继落网,陆续退还50多万元赃款。

该团伙有组织、集团化地套取“新农合”基金,内部也有明确的分工。“中间人”负责寻找“假患者”,收集到医保本和身份信息后,交给“上线”。办案民警解释,“上线”其实就是医院里的“医托”,负责制造假的诊断材料、住院收费票据。最后,再由“下线”——实际报账人或者委托人拿着假材料报销,分赃。

收费票据防伪性不强各地款式不一审核难度大

可以看出,不法分子的作案手法并不高明,却能屡屡得手,他们到底是钻了哪个环节的漏洞呢?

按照规定,新农合参保农民报销时需要提供的材料包括:诊断证明、住院病历、出院总结、费用明细清单、收费依据以及报销人的医保本及身份证件。其中前三样及手术记录等材料提供复印件,加盖医疗机构公章即可。

而如今各种假冒印章仿真度高,如用一份真实的住院病历资料,只是换掉假冒人员的个人基本信息,在印章完善的情况下,很难辨别真伪。

不仅造假容易,各省不同医疗机构的收费票据大小、规格、颜色也是千差万别,且没有明显的防伪识别标识。这也给审核人员审核外地就医票据带来难题。

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