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南京医科大学学报（社会科学版）京医科大学学报（社会科学版） 第4期 总第111期
· 368 · Journal of Nanjing Medical University（Social Sciences）of Nanjing Medical University（Social Sciences） 2022年8月
Journal

Research on the current situation and countermeasures of medical

insurance fund fraud

——Use 372 judgment documents as analysis samples
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HU Jiuying ，WU Juan ，SONG Yueli ，ZHOU Yi ，DING Yu 4
1. School of Health Management，2. School of Humanities Medicine，3. First Clinical Medical School，Anhui Medical University，
Hefei 230032；4. Information Center，the First Affiliated Hospital of Anhui Medical University，Hefei 230022，China
Abstract：The medical insurance fund is closely related to people’s livelihood，and its fraudulent behavior
will seriously damage people’s vital interests. In this paper，based on the 372 documents of medical insurance
fund fraud cases through“China judgment online”from early 2011 to late 2021，it reveals the typical
characteristics of fraudulent medical insurance fund behavior are diversified subjects，complex means and
behavior concealment. Additionally，based on the theoretical ideas related to crime prevention and the basic
framework of the current crime prevention system in China，the paper puts forward several countermeasures by
deepening institutional reform，building a regulatory system，optimizing market order，raising the cost of
crime，and improving the rule of law and moral education，aiming to build up an all⁃round，multi⁃level and all⁃
participant system for preventing fraudulent and deceptive behavior of medical insurance funds，and to provide
scientific decision⁃making references for the safe usage and healthy management of the medical insurance fund.
Key words：medical insurance fund；fraud；crime prevention