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近日,有媒体报道,经广东省某市人民法院开庭审理,认定该市某区社保局工作人员罗某某通过伪造虚假疾病信息、就医配药信息和医疗费报销材料,让50名参保人员“被患病”后申请医疗费报销,金额高达近千万元,案发时,其中920余万元已得手。又是一起“内鬼”作案!这几年,“人人享有基本医疗保障”的目标已初步实现,医保工作重心已逐步从制度建设转为如何提升经办服务管理能力。同时,医保内部的经办风险开始凸显,但似乎尚未引起足够的重视。
Recently, some media reported that after hearing the case of a people’s court in a certain city in Guangdong Province, Luo Moumou, a member of the Social Security Bureau in a certain district of the city, found that 50 people insured by falsifying false medical information and medical expenses reimbursement materials, After being “sick” apply for reimbursement of medical expenses, the amount of up to nearly ten million yuan, the incident, of which more than 920 million have succeeded. In recent years, the goal of “Everyone has Basic Medical Security” has been initially realized. The focus of medical insurance work has gradually shifted from system construction to how to improve the ability to handle service management. In the meantime, the handling risks inside the medical insurance are beginning to show prominence, but it seems that it has not given enough attention.