A case in Jinhua City won the first prize in the National Smart Medical Insurance Competition

The reporter learned from the Municipal Medical Insurance Bureau yesterday that the final of the 2024 National Smart Medical Insurance Competition ended in Chongqing, and the Municipal Medical Insurance Bureau’s project “Precision Crackdown on Drug Reselling Supervision Plan Based on Decision-making Pivot” won the first prize of the competition.

It is reported that a total of 593 teams participated in this competition nationwide. After the preliminary and semi-finals, 70 teams finally entered the finals. The project “Precision Crackdown on Drug Reselling Supervision Plan Based on Decision-making Pivot” participated by the Municipal Medical Insurance Bureau applies the smart medical insurance thinking mode. By organically combining medical laws, statistical analysis and logical reasoning, the data logic of the seized drug reselling cases and the behavioral characteristics of drug buyers are extracted, effectively improving the quality and efficiency of supervision. Our city applied the project to the field of hemophilia for monitoring and cracked a case of fraud and insurance fraud by hemophilia patients. The case was selected as a typical case of punishing medical insurance fraud crimes in accordance with the law announced by the Supreme People’s Court and the Supreme People’s Procuratorate in 2024.