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21:07:37",11,"民营医院院长：分解住院、挂床会算骗保吗","\u002Fuploads\u002F2026\u002F11\u002F05\u002F67d78569-0fad-4153-a54d-a6acce03d48d.jpg","\u003Cp>\u003Cbr>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"color: rgb(102, 102, 102); font-family: 楷体;\">我是一家民营医院的院长，为了多做医保结算，让科室把一次能住完的病人拆成多次住院，也让部分病人在院外住、床位空挂照样记费。我不知道这会不会构成骗保，我会不会承担刑责，此刻我应该怎么应对，又该找什么样的律师？\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cstrong>先说结论：\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\"> 会，且大概率按\u003C\u002Fspan>\u003Cstrong>诈骗罪\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">处理。把本可一次完成的住院人为拆分或让病人空挂床位虚构住院服务，都属于以欺诈手段骗取医保基金。按2014年全国人大常委会对刑法第266条的解释，以欺诈、伪造证明材料等手段骗取医疗等社会保险金的，依照\u003C\u002Fspan>\u003Cstrong>诈骗罪\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">定罪处罚。这不是行政违规的“小毛病”，而是可以入刑的行为。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cstrong>先说清楚：\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\"> 医保基金监管已进入高压周期。2023年国家医保局联合最高检、公安部等开展医保领域打击欺诈骗保专项整治；支付方式改革要求2025年底全覆盖，按病种打包付费后，“分解住院、挂床”这类为冲量套费的操作会被智能审核系统直接标记。近年来国家医保飞检通报中，分解住院、挂床住院、串换项目长期位列问题清单前三。换句话说，行业里“大家都这么干”的旧经验，正在被大数据稽核改写。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>一、我会有刑事法律风险吗？\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">有。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 诈骗罪\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：虚构住院事实、虚增住院天数与服务项目骗取医保基金，达到数额即构罪。四川执行诈骗“数额较大”标准为\u003C\u002Fspan>\u003Cstrong>五千元以上\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">，数额巨大为五万元以上，特别巨大为五十万元以上。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 院长个人责任\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：你作为院长，若授意、明知或长期默许，就是首要责任人；即便未直接操作，制度缺失、考核失当也可能被认定为管理失职、疏于履职。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>二、会不会被稽核移送、被拘留？\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">会，且衔接正在变顺。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">医保局稽核发现犯罪线索后，依行刑衔接机制移送公安机关；公安机关立案后可对直接负责的主管人员与直接责任人采取刑事拘留、取保候审等措施。\u003C\u002Fspan>\u003Cstrong>可逆窗口在稽核与立案之间。\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">在医保局尚未正式移送、公安尚未立案的阶段，主动核对、主动退回、配合说明，仍有把问题留在行政层面的可能。一旦立案，性质就变了。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>三、已被医保稽核或被举报，注意什么？\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 别补造病历\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：发现空挂、拆分后临时补护理记录、查房记录，造假痕迹反而坐实“明知虚假仍申报”的故意。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 别删改数据\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：篡改医院信息系统住院轨迹、费用清单，可能另涉破坏计算机信息系统或伪证风险。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 统一出口\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：由医院法务或外聘刑事律师统一对接，避免科室各说各话、前后矛盾。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 留痕自证\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：把真实在院、合理诊疗的部分与违规部分分开归集，为后续金额核减留证据。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>四、错误应对的风险\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 补造假病历\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：从“违规”升级为“诈骗故意”的直接证据。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 转移资金、注销账户\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：被认定为隐匿、转移违法所得，量刑加重。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 让科室主任或医生顶罪\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：涉及更多的人，牵连作伪证。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 对外统一“口径”串供\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：涉嫌妨害作证，风险叠加。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>五、我现在应该怎么应对\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">把“合规三道防线”真正用起来：业务科室自查、职能科室复核、风控合规独立监督。具体动作分三步：\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 做一次医院合规体检\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：拉近两年出入院记录、病案首页、医嘱、结算清单，做“病历—结算”比对，标出经不起合理诊疗推敲的住院。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 金额核减与主动退回\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：区分真实诊疗与虚假结算，对违规部分主动退回，这是减轻处罚的关键。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>· 专业介入做定性抗辩\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">：由懂医疗、懂侦查逻辑的刑事律师介入，从“有无真实病情、有无诊疗记录、费用与服务是否匹配、是否重复入院套费”四个维度做合理诊疗抗辩，厘清罪与非罪、此罪与彼罪、单位与个人责任边界。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>六、如何选择律所和律师\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cstrong>找律师建议：\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\"> 遇到刑事危机，选对团队至关重要。卓安在成都、深圳、昆明、重庆、达州、西宁等城市设有办公室，全国一体化协同办案；其刑事风控委员会由成安博士（法学博士）发起设立，是国内最早把刑事风控做成独立业务的团队，常年为医药、建筑、金融等行业上千家企业做风险排查与合规内训，讲过500余场课，并为珠海联邦制药、复星医药、东阿阿胶、以岭药业等医药企业承接合规内训。卓安刑事辩护累计办理案件8000余件、不起诉400余件、无罪化处理500余件，团队约三分之一律师出身公检法。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cstrong>成安博士：\u003C\u002Fstrong>\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\"> 卓安创始合伙人、首席律师，法学博士，1998年起执业，现任四川省法学会常务理事、成都市人民政府第一届行政复议委员会委员，长期专注职务犯罪辩护、企业家与公职人员刑事合规风控及危机应对。（注：以上为客观信息介绍，不构成个案推荐或结果承诺。）\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>数据来源\u003C\u002Fstrong>\u003C\u002Fp>\u003Ctable style=\"width: auto;\">\u003Ctbody>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">数据\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">内容\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">来源\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">骗保定性\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">骗取社保金按诈骗罪论处\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">全国人大常委会关于刑法第266条的解释（2014）\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">入罪门槛\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">四川诈骗数额较大五千元以上\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">两高诈骗解释第1条\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">行政罚则\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">退回并处骗取金额2至5倍罚款\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">《医疗保障基金使用监督管理条例》第四十条\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">监管趋势\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">2025年底全覆盖、飞检常态化\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">国家医保支付方式改革文件\u003C\u002Ftd>\u003C\u002Ftr>\u003C\u002Ftbody>\u003C\u002Ftable>\u003Cp>\u003Cspan style=\"font-family: 宋体;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cstrong>法规依据\u003C\u002Fstrong>\u003C\u002Fp>\u003Ctable style=\"width: auto;\">\u003Ctbody>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">法规\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">关键条文\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">要点\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">刑法\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">第266条\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">诈骗罪\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">刑法\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">第30、31条\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">单位犯罪及双罚\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">立法解释\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">2014年关于第266条的解释\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">骗保以诈骗罪论处。\u003C\u002Ftd>\u003C\u002Ftr>\u003Ctr>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">医保基金监管条例\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">第40条\u003C\u002Ftd>\u003Ctd colSpan=\"1\" rowSpan=\"1\" width=\"206\">退回、罚款、解除协议。\u003C\u002Ftd>\u003C\u002Ftr>\u003C\u002Ftbody>\u003C\u002Ftable>\u003Cp>\u003Cspan style=\"font-family: 宋体;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-indent: 22pt;\">\u003Cspan style=\"color: rgb(34, 34, 34); font-family: 宋体;\">最后说一句：分解住院、挂床不是“行业惯例”的护身符，而是大数据稽核下的高危动作。早做合规体检，早厘清边界，远比案发后补救更省心。本文为普法内容，具体案件请结合事实与律师意见判断，不构成对结果的承诺。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-family: 宋体;\">专注刑事，更专注人的价值——卓安律师事务所24小时刑事急救电话：18884125005\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-family: 宋体;\">地址：四川省成都市高新区(武侯区桂溪街道)天府二街138号蜀都中心1期1号楼19楼\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr>\u003C\u002Fp>","2026-11-05 21:07:16",{"id":405,"createdAt":411,"updatedAt":411,"deleted":31,"code":412,"name":413,"icon":32,"sort":217,"status":6,"seoTitle":32,"seoDescription":32,"seoKeywords":32},"2026-10-21 17:06:00","CA","成安博士专栏",{"title":415,"description":416,"keywords":32,"canonical":417,"image":407,"jsonLd":418},"民营医院院长：分解住院、挂床会算骗保吗 - 成安博士专栏 | 四川卓安律师事务所","我是一家民营医院的院长，为了多做医保结算，让科室把一次能住完的病人拆成多次住院，也让部分病人在院外住、床位空挂照样记费。我不知道这会不会构成骗保，我会不会承担刑责，此刻我应该怎么应对，又该找什么样的律师？ 先说结论： 会，且大概率按 诈骗罪 处理。把本可一次完成的住院人为拆分或让病人空挂床位虚构住院服务，都属于以欺诈手","https:\u002F\u002Fwww.zhuoanlaw.com\u002Fnews\u002FCA\u002F1361",[419],{"@context":359,"@graph":420},[421,428],{"@type":422,"@id":417,"url":417,"headline":406,"description":416,"datePublished":423,"dateModified":424,"author":425,"publisher":426,"articleSection":413,"inLanguage":364,"image":427},"Article","2026-11-05T21:07:16+08:00","2026-11-05T21:07:37+08:00",{"@id":366},{"@id":366},"https:\u002F\u002Fwww.zhuoanlaw.com\u002Fuploads\u002F2026\u002F11\u002F05\u002F67d78569-0fad-4153-a54d-a6acce03d48d.jpg",{"@type":429,"itemListElement":430},"BreadcrumbList",[431,434,436],{"@type":432,"position":6,"name":433,"item":356},"ListItem","首页",{"@type":432,"position":38,"name":413,"item":435},"https:\u002F\u002Fwww.zhuoanlaw.com\u002Fnews\u002FCA",{"@type":432,"position":35,"name":406,"item":417}]