舞出我人生

Beijing police bust fraud gang that made member undergo 20 CT scans_我的网站

A |     日报讯（记者崔丛丛）近日，省医保局联合省发展改革委、省卫生健康委研究制定了《关于医保支持基层医疗卫生服务发展若干措施》，对优化医保基金管理、深化支付方式改革、完善医保待遇政策、落实药品供应保障、优化价格与服务管理、提升基层业务能力等6方面16项工作进行落实，切实保障基层群众“好看病”“看好病”“少花钱”。    

    Photo: VCGA 16-member insurance fraud gang in Beijing allegedly staged more than 20 fake traffic accidents involving vehicles and electric bicycles, with one member undergoing more than 20 CT scans in three months to help obtain medical proof for fraudulent claims, according to a report by China News Service, citing multiple media reports. 
The case was uncovered in April 2026, when the insurance company detected multiple suspicious claims through its anti-fraud system. The insurer found that more than 10 cases shared unusual similarities: Electric bicycle riders allegedly fell after collisions and suffered tailbone fractures, while the injured parties also came from a similar region.
Police later found that the suspects, led by a man surnamed Zhao, had allegedly formed a professional fraud ring. They chose quiet roads at night or in the evening, used their own vehicles and electric bicycles to stage crashes, or deliberately created accidents to make drivers appear at fault.
Investigators said the gang's key tactic was a "substitution trick" during medical examinations. A member surnamed Qi, who had actually suffered a tailbone injury, was allegedly used as a fake victim after staged crashes and went for CT scans to obtain medical records.
To receive a payment of 1,000 ($150) to 2,000 yuan each time he helped with the "injury verification," Qi allegedly ignored potential radiation risks and underwent more than 20 CT examinations within three months.
Police said the gang carried out more than 20 fraudulent cases between January and April, obtaining over 300,000 yuan ($44,600) in insurance payouts from six companies in Beijing. All 16 suspects have been arrested.
Global Times 
。

B | 若干措施提出，优化医保基金管理、强化基层倾斜保障，省下的钱留给基层。科学编制基金总额预算，年度新增医保基金原则上要适当向基层倾斜；推进紧密型县域医共体总额付费，合理做好医共体内结余留用分配，加大向基层医疗卫生机构倾斜力度。此外，落实医保基金预付政策，向管理规范、基金支出占比高、信用良好等符合条件的基层定点医疗机构加大预付力度。省将深化支付方式改革、引导分级诊疗落地，把常见病留在基层。

C | 推行基层门诊多元支付，探索适宜基层的门诊按人头付费与慢病管理相结合的多元复合支付方式。扩大基层病种（组）数量，推动同病同付，完善住院按病种付费配套机制，加大对基层倾斜力度，在现行基层医疗卫生机构基本系数基础上增加不少于5%。完善医保待遇政策、提升基层就医获得感。职工医保普通门诊统筹起付标准原则上确定为100元，政策范围内支付比例不低于50%。对符合条件的慢病患者，基层医疗卫生机构可单次开具不超过12周用药的长期处方。同时，优化住院差别化支付，合理设置不同级别医疗机构住院报销比例。此外，扩大基层医保定点覆盖面，及时将符合条件的基层医疗卫生机构纳入医保定点管理。根据若干措施，省还将优化价格与服务管理、激发基层服务活力。一是规范基层医疗服务价格项目，鼓励基层医疗卫生机构规范使用上门服务费、安宁疗护费等价格项目。二是落实基层医疗卫生机构一般诊疗费政策，分类优化基层价格体系，合理缩小各级医疗机构间一、二级手术及护理、影像检查、检验等价格项目的价格差异；推进换药、注射、输液、采血等项目区域内价格相对协同。若干措施明确，健全医共体内药品“采购、配送、使用”一体化管理机制，实现县乡村处方规范流转、用药需求精准匹配，加强药品供应保障、确保基层用药安全。另外，省将不断丰富和拓展医保智能体场景应用等，增强基层业务能力、提高基层服务水平。

Current article:http://pva.suilaoheirenzhaizhaikang.sbs/bhmi/hz71m.html

Published on:09:08:23