Recently, media reports have revealed that some private hospitals are allegedly using so-called ‘entrapment funds’ to systematically defraud the national medical insurance system. These ‘entrapment funds’ refer to internal hospital budgets or incentive schemes designed to lure or bribe insured individuals or intermediaries into fabricating medical services—such as falsifying diagnoses, issuing unnecessary prescriptions, or registering ‘phantom inpatients’—to generate fraudulent claims for reimbursement from public health insurance. Such practices not only blatantly violate China’s Social Insurance Law and the Regulations on the Supervision and Administration of Medical Insurance Funds, but also undermine the fairness and sustainability of the healthcare system while harming the interests of millions of policyholders. Regulatory authorities have launched targeted crackdowns, emphasizing a ‘zero-tolerance’ stance: confirmed violations will result in fund recovery, license revocation, and even criminal prosecution. Experts urge strengthening AI-powered monitoring systems, improving whistleblower reward mechanisms, and raising public awareness to better detect and prevent fraud, thereby safeguarding the public’s essential medical funds.
近期，有媒体报道部分民营医院涉嫌通过设立所谓‘围猎’专款，系统性骗取医保基金。所谓‘围猎’专款，是指医院内部设立专项资金或激励机制，用于诱导、收买参保人员或中间人，通过虚构诊疗项目、虚开药品、挂床住院等手段，制造虚假医疗记录，从而向医保部门申请报销，非法套取医保资金。此类行为不仅严重违反《社会保险法》和《医疗保障基金使用监督管理条例》，也损害了广大参保群众的切身利益，破坏了医保制度的公平性和可持续性。监管部门已对此类问题展开专项整治，强调对骗保行为‘零容忍’，一经查实将依法严惩，包括追回资金、吊销执照乃至追究刑事责任。专家呼吁，应加强医保智能监控系统建设，完善举报奖励机制，同时提升公众对医保欺诈行为的识别与防范意识，共同守护‘看病钱’‘救命钱’的安全。
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