「接骨院が不正請求の疑い」 岐阜市議、返還求め住民監査請求

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岐阜市が、市内の接骨院から老人保険の療養費(医療費)約100万円を不正請求でだまし取られた疑いがあるとして18日、市がこの接骨院に支払った額の確定や不正請求額の返還、刑事告訴するよう求める住民監査請求を行った。
接骨院は2004年1月から、過去4年間、一度も通院していない80歳代女性の名義で毎月2万円程度の医療費を請求し、市から約100万円の支払いを受けた。女性は、4月に市から届いた高額医療費支給申請に伴う明細書に、治療を受けていない接骨院からの請求が含まれているのに気付き、市に届け出た。
市は、県とともに事実を確認し、不正請求があれば刑事告訴を検討する。老人保険では医療費の1~3割が患者負担で、残りを市町村に請求する仕組み。

その後、この接骨院は04年1月~08年3月までに不正請求した約98万円を市に返還している。同市は、この女性以外に不正請求の疑いのある数件について県と岐阜社会保険事務局に情報提供しており、総額はさらに膨らみそうだとのこと。
同市は監査結果を待って刑事告訴するらしい。

これも古典的な不正の手口。「接骨院の前を通ると通院したことになる」という言い伝えもあります。過去に、患者が外国に行っていて治療を受けていないのに療養費を請求してバレタ接骨院もありました。

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このページは、honetsugimanが2009年10月15日 22:34に書いたブログ記事です。

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