九江通报四起参保人员违规典型案例 处理来了→
<p style="text-align: center;"></p><p><br/></p><section data-support="96编辑器" data-style-id="29626" style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 5px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-align: center;"><section style="margin: 0px 0px 0px 10px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; width: 2.3em; transform: rotateZ(0deg);"></section><section style="margin: -7px 0px 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important; box-shadow: rgb(255, 224, 41) 0px 0px 5px; border-width: 1px; border-style: solid; border-color: rgb(255, 219, 133);"><section style="margin: 0px; padding: 15px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important; color: rgb(149, 149, 149);"><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 15px; letter-spacing: 2px; text-indent: 40px; box-sizing: border-box !important; overflow-wrap: break-word !important;"> <span class="Apple-converted-space"> </span></span><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 15px; letter-spacing: 2px; text-indent: 40px; box-sizing: border-box !important; overflow-wrap: break-word !important;"> </span></strong><span style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(0, 0, 0); font-size: 15px; letter-spacing: 2px; text-indent: 40px; box-sizing: border-box !important; overflow-wrap: break-word !important;">2020年九江各级医疗保障部门认真贯彻《九江市2020年打击欺诈骗保专项治理实施方案》（九医保字34号）、《九江市医保定点医疗机构规范使用医保基金行为专项治理实施方案》（九医保字53号）文件，持续构筑打击欺诈骗保高压态势，并取得阶段性成效。年底前是突击刷卡等欺诈骗保行为高发期，各地扎实开展“回头看”工作。现将部分参保人员违规典型案例进行全市通报，警示全市广大参保人员自觉遵守法律法规，共同维护医保基金安全。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 43px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 82, 255);">一、庐山市蓼南乡新华村村民左某冒名顶替住院案</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 43px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 0, 0);">经查，庐山市蓼南乡横岭村建档立卡贫困户刘某英出借社保卡给新华村村民左某冒名顶替住院。根据《社会保险法》相关规定，庐山市医疗保障局拒付左某在九江学院附属医院住院费用233249.62元，并将左某及丈夫尹某移交公安机关，将出借人刘某英移交扶贫办处理。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 43px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 82, 255);">二、德安县余某外伤欺诈骗保案</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 43px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 0, 0);">经查，德安县参保人余某将存在有第三方情况下的意外伤害医疗费用进行报销骗取医保基金。根据《社会保险法》的相关规定，当地医保局追回余某报销中统筹支付4587.89元的医保基金，并对其进行严肃批评教育。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 40px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 82, 255);">三、都昌县汪墩乡杨储村委会观峦村村民程某彩欺诈骗保案</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 40px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 0, 0);">经查，汪墩乡杨储村委会观峦村村民程某彩在帮他人做工时受伤后被送往都昌县中医院住院治疗，医疗总费用由相关责任人全额赔付，却故意隐瞒实情，以意外摔伤无第三方责任人的名义住院，骗取医保基金。依据《社会保险法》相关规定，全额追回医保基金18642.07元，并对当事人严肃批评教育，列入都昌县医保失信人员名单；对汪墩乡政府和都昌县中医院涉案相关人员违规线索移送相关部门进行处理。</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 40px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 82, 255);">四、都昌县大港镇高塘村村民石某某冒名顶替住院案</span></section><section style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; text-indent: 40px; text-align: justify; line-height: normal;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px; color: rgb(0, 0, 0);">经查，都昌县大港镇高塘村村民石某庆出借医保卡、贫困证给其哥哥石某某，先后在大港卫生院住院和县第二人民医院住院报销，骗取医保基金。根据《社会保险法》相关规定，追回医保基金11029.59元，并对当事人进行严肃批评教育，列入都昌县医保失信人员名单。</span><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important; font-size: 15px; letter-spacing: 2px;"></span></strong></section></section></section></section></section></section><p></p><section style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(51, 51, 51); font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; 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word-wrap: break-word !important; font-size: 14px; letter-spacing: 0.544px; color: rgb(178, 178, 178); overflow-wrap: break-word !important;">来源：局基金监管科</span></p></section></section></section></span></section></section></section><p></p><link rel="stylesheet" href="http://bbs.jjxw.cn/source/plugin/wcn_editor/public/wcn_editor_fit.css?v134_yF3" id="wcn_editor_css"/> 医疗无小事，应该从重惩治。
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