A news report that "a patient's family in Anhui found that the top three hospital overcharged 100,000 medical expenses showed that it overcharged 210,000" caused public concern.

Netizens have issued a series of questions: Why do hospitals cheat medical insurance so easily? If the family didn't report it, would it have been discovered? Are there any other similar problems in other places and hospitals? For the investigation of the case of overcharging medical expenses in Wuhu second hospital, is it just a refund?

The reason why the public has shown such a big reaction is that such overcharges are so easy, and anger can be so smooth to take money from the national health insurance fund.

All in all questions, summed up there are so many.

First of all, how should we characterize such "overpayment"? On July 18, 2023, the Medical Security Bureau of Anhui Province received a complaint report from Yang, reflecting that the Second People's Hospital of Wuhu City illegally used medical insurance funds through fictitious and exchanged diagnosis and treatment services during his father's hospitalization for cerebral hemorrhage.

After investigation, the hospital had problems such as over-diagnosis and treatment, over-inspection, over-prescribing, repeated charges, applied charges, and over-standard charges, involving the total cost of illegal medical treatment of 218,200 yuan, including the illegal use of medical insurance funds of 187,000 yuan.

The hospital will not be unaware that they overcharge the National Medical insurance fund, and these techniques identified in the investigation report are illegal and deceptive.

Now, Anhui province and Wuhu municipal medical insurance authorities recovered 186,900 yuan of medical insurance funds from Wuhu Second Hospital, and imposed a penalty of 56,000 yuan, while requiring it to refund 31,200 yuan of out-of-pocket expenses for the patient's family. In addition, the case was transferred to the public security organs and health departments for further processing.

It can be seen that netizens believe that this is a case of "insurance fraud", which belongs to illegal acts, and the relevant personnel should be investigated for legal responsibility according to law, and such calls are based on law.

People are more questioning, why do hospitals overcharge medical insurance fees in violation of laws and regulations? Where are the management gaps? Clarifying this issue may be more important than dealing with the perpetrators of this case.

There is a saying that hospitals overcharge to increase revenue.

For example, the income of the hospital mainly depends on the sale of drugs and consumables, rather than the quality and effect of the service, which leads to the incentive of the hospital to carry out some unnecessary examinations and treatments, as well as the use of some expensive drugs and consumables, thereby increasing the medical costs and obtaining more profits.

Such claims may have some basis in reality, but they are hard to convince.

Medical insurance fund is an important system established by the state to protect the basic medical needs of the people, which involves the vital interests of thousands of households.

The use of medical insurance funds in accordance with the law is the legal responsibility of every hospital and every relevant personnel, including medical staff and patients.

There are regulatory loopholes in hospitals and medical insurance departments, which is the main objective reason for overcharging. The hospital can falsely report the quantity, and when issuing the list of medical expenses, it can deliberately exaggerate the number of inspections, the dosage of drugs, the number of consumables, etc., so as to overcharge.

In the declaration of medical insurance settlement, the hospital can change the ordinary drug code to a special drug code, so as to overcharge.

When using the medical insurance fund, the hospital can overcharge by not following the prescribed scope and standards, using some drugs and consumables that do not meet the medical insurance catalogue, or exceeding the medical insurance limit.

All of this is very easy for people who want to exceed their income subjectively. This is a real loophole.

Only by plugging the loopholes can we prevent the overpayers from taking advantage. Plugging loopholes requires comprehensive treatment. What we need now is to find out together and investigate together.

What is special about this case is that it involved only one patient and was identified by the patient's family in a statistical model and confirmed by the health insurance department.

If it is not such a reporting method, will it be found true? Some netizens believe that only if the responsible person is dealt with, can the example be made, and it is not unreasonable to return the money.