随着我国社会保险事业的快速发展,医疗保险欺诈现象也不断增多,严重威胁到医疗保险基金和医保制度的稳健运行.作为保险欺诈"重灾区"的欧美国家,在反医疗欺诈措施方面积累了不少经验,特别是政府与市场的相互配合,医保反欺诈取得显著成效.文章论述了国外医疗保险反欺诈机制,得出建立医疗保险反欺诈机构、充分发挥非营利组织的补充作用、加强对医疗和医保机构欺诈的制约与监管、利用现代信息技术提高反欺诈水平等启示.%With the rapid development of China's social insurance,the phenomenon of medical insurance fraud is also increasing,which seriously threatens the comprehensive operation of health insurance funds and medical insur-ance system. Because of the cooperation between the government and the market,Europe & US have accumulated a lot of experience and achieved considerable success in anti-medical fraud as the"harder-hit area"in insurance fraud. This paper discusses the anti-fraud mechanism of foreign medical insurance to establish medical anti-fraud agencies within the government,and give full play to the complementary role of non-profit organizations to strengthen the con-trol and supervision of medical insurance and health care institutions and uses modern information technology to im-prove anti-fraud level.
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