中国农村卫生事业管理2025，Vol.45Issue(4)：286-291,6.DOI:10.19955/j.cnki.1005-5916.2025.04.010
医院欺诈骗保行为路径与管控的组态分析
A configuration analysis of the path and control of medical insurance fraud in hospitals
摘要
Abstract
Objective To analyze the behavioral path of medical insurance fraud in hospitals,and to put forward regulatory suggestions for more effective supervision of medical insurance funds.Methods Based on 95 typical cases of medical insurance fraud exposed by the National Medical Security Administration,the critical factors and paths of insurance fraud were explored by using the method of clear set qualitative compara-tive analysis.Results At present,the medical insurance fraud behavior of hospitals was generated under the coupling of multiple factors,which mainly included three paths:the fraud together with patients,the false ex-change of medical treatment and the illegal charging of forged data.Conclusions Medical insurance fraud in hospitals is changing from single subject to multi-subject complicity.In the future,it is necessary to strengthen the supervision and management of the hospital subject and his behavior,strengthen the joint prevention and control of each department,and improve the frequency and level of examination,and strengthen the penalty for insurance fraud,in order to reduce the incidence of fraud.关键词
欺诈骗保/医院/组态分析Key words
Insurance fraud/Hospital/Configuration analysis分类
医药卫生引用本文复制引用
赖玲琪,徐皖豫,张泽洪..医院欺诈骗保行为路径与管控的组态分析[J].中国农村卫生事业管理,2025,45(4):286-291,6.基金项目
国家社会科学基金项目(23BGL291) （23BGL291）
