The reporter investigates secretly: The hospital defrauds of the medical insurance way variously

The reporter investigates secretly: The hospital defrauds of the medical insurance way variously
Informant newspaper material
The doctor exposes to the sun the clinic and deceives and protects shady deal
Traditional chinese medical science clinic of Xuanwu District Guangan of Beijing (hereafter referred to as the traditional chinese medical science clinic of Guangan) ,Lie in Guangan hutong of Xuanwu District.Inquire about and see through human resources and social security round website of Beijing, the traditional chinese medical science clinic of Guangan is really a fixed organization of medical insurance, the classification of the hospital is foreign Chinese medicine, and the legal representative registered is Yu ZhenHai.
Zhang Hua (assumed name) ,Have practised medicine for nearly two years here. He tells reporters, as to Yu ZhenHai and situation of the whole traditional chinese medical science clinic of Guangan, he watches with the tail of one's eye.
Zhang Hua says, the traditional chinese medical science clinic of Guangan opened on November 26, 2006. Open a the last one month, to practise medicine fairly relatively more normal clinic, until December that year, after taking down the brands of the medical safety unit, defrauded of the behavioral beginning of protecting, grew in intensity later.
Make articles such as facial film, buying blood pressure appearance and health care pillow,etc., not in the submitting an expense account in the range of medical insurance, but the doctors of the clinic have brought all these into the range of the medical insurance through juggling things in the document.
However, the clinic " does things " recently Becoming very prudent, generally only the acquaintance introduced, will operate like this.
The reporter investigates secretly
Women actually could handle man patient's disease in medical insurance
According to the situation that Zhang Hua talks about, on March 31, the reporter holds a lady's medicine and breaks even in company with patient Mr. Li, want 2 layers of traditional chinese medical science clinic of Guangan.Mr. Li finds president Yu ZhenHai of the traditional chinese medical science clinic of Guangan, make facial film in the name of treating youthful small pox.
It was 2 o'clock in the afternoon at that time, Yu ZhenHai was out, the staff members of the hospital let Mr. Li come again on Saturday. Propose, introduce come on one acquaintance as Mr. Li, one middle aged woman appear. She has not worn the work clothes, a suit of plainclothesmans, after inquiring the acquaintance's name again, let Mr. Li wait a moment, say that has gone out to the president, will come back soon.
About 20 minutes later, Yu ZhenHai appeared. Prove behind the one's purpose in coming, ZhenHai Yu say need, make one auxiliary acupuncture except that small pox treat, then make facial film. In the talk, Mr. Li claims to have no medicine to break even, unable to submit an expense account, can take others' medicine and break even and open the invoice. Yu ZhenHai says, " all right, this will say in a moment. "
Subsequently, Mr. Li begins to accept acupuncture. In the course, Mr. Li has a chat to the thing that the medical insurance submits an expense account again, Yu ZhenHai says: All right if medicine break even, but don't advocate to the outside. "Does not allow like this, it is all right for oneself to know. "
In the talk, Yu ZhenHai has a chat to oneself, he is 67 years old this year, is the doctor of a hospital of Beijing before this, retire, practise medicine here. Soon after acupuncture was finished, Yu ZhenHai began to make facial film for Mr. Li, lasted half an hour to do the course of the facial film.
The facial film except that small pox turns the medical insurance into massage and leaves
At about 3 o'clock on the same day afternoon, on shake a handwritten document of sea, the charging item above, in order to treat the fee. After getting the document, does Mr. Li inquire that so be problematic shaking the sea? "No, it would be better if you broke even to pay dues holding list and medicine, the following person will know how to open. " Yu ZhenHai says.
Mr. Li come the first floor pay dues subsequently, break even the intersection of women and medicine of friend and bill, give and charge personnel. At this moment, ZhenHai Yu reach the first floor too, charge at the beginning personnel speak. Charge personnel look up, watch the intersection of eyes and Mr. Li, bow and draw a bill immediately.
Invoice turn on, come out, charge for 320 entirely, charge content add up to 4, respectively for change dressings and auricular acupoints pigeonhole beans, move the pot, massage manipulation.
The reporter watches the invoice finding, the content of changing dressings is 5 persons, charges 10 yuan each time, it is 50 yuan altogether. It is 4 persons that the pot leaves, charges 10 yuan each time, it is 40 yuan altogether. And the massage manipulation is 10 persons, charges 20 yuan each time, it is 200 yuan altogether. The auricular acupoints presses the beans and amounts to 30 yuan. Several contents are added, it is just the price of 320 yuan.
Charge on the document that personnel open, is writing the women name that Mr. Li offered. The reporter holds Mr. Li's document to learn after inquiring, the therapeutic content made above, within the range that the medical insurance submits an expense account. At the end of the year, can be submitted an expense account by the unit according to the document.
Mother bought the blood pressure appearance and submitted an expense account with son's name
On April 1, it is likewise the afternoon, there are few patients of traditional chinese medical science clinic of Guangan, Yu ZhenHai has been here either.
The reporter accompanies Mr. Li to get to the acupuncture first, attempt to buy the blood pressure appearance. Because has not offered acquaintances introduced out, the other side does not call it for sale.
And then, it was strange through the department that Mr. Li wanted one layer, only one one inside is surnamed that a doctor of the face is here. Mr. Li say to him mother good cervical vertebra have, want, buy one the intersection of health care and pillow, it is one uncle Yang that buy here that introduce, come on. The face doctor says, there is not the pillow at present, let Mr. Li step on and write, phone sometimes.
At this moment, Mr. Li calls mother strangers, have no medicine to break even, it is unable to submit an expense account, want to look for president Yu ZhenHai, look for a medicine to break even and walk and submit an expense account. Hear this, face doctor say, need blind to let, say just, " such a thing don't look for somebody arbitrarily " to him . In inquire, learn after Mr. Li have medical insurance can wipe out, face doctor say, " walk to submit an expense account right away all right you " . See Mr. Li expresses the doubt, the face doctor says, OK, he will turn on the list then, the cashier knows how to open.
The one in the industry says
Defrauding of the medical insurance has many ways
The insider introduces, is " deceived and protected " Trick main yes the following aspects: It kept accounts, changed the case history, name of changing dressings, compiled the prescription, practised fraud etc. in the document that false.Because 85% to 90% are all settle with the medical insurance centre directly by the hospital in the medical expenses of the patient in hospital, many hospitals have typed the mind on the impatient's case history, prescription. Bring, change, come, say some doctor revise, effect an insurance case history of patient without authorization by case history, the treatment is changed into surgery treatment, upgrade chronic leukemia to acute leukemia such as perform the operation malignant tumour. Upgrade through diagnosing, obtain higher medical insurance and pay the funds by norm.
Name of changing dressings and arrange prescription is give at one's own expense medicine or medicines outside the catalogue that patient turn on medical worker, turn out to be medicines in the catalogue, achieve the goal of obtaining the funds from the medical insurance centre.
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