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August 20, 2011

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Woman, niece admit medical insurance fraud

A 79-year-old woman and her niece pleaded guilty yesterday to defrauding medical insurance out of nearly 200,000 yuan (US$31,250) by faking medical bills and documents.

Both Liang Maodi and her niece, Liang Meijuan, admitted the fraud in the Zhabei District People's Court.

The elderly woman said she was taught to cheat the system by a self-described retired doctor she met at a tonic exhibition, and that most of the ill-gotten money went to him. The man has not been caught.

The crime was detected in May last year, when Liang Meijuan went to the Zhabei District Medical Insurance Center to seek reimbursement of about 22,000 yuan. The money was supposedly for hospital fees for Liang Maodi for treatment for heart disease and stroke in a Suzhou hospital in neighboring Jiangsu Province.

Local medical insurance covers expenses of Shanghai retirees who live in other provinces. The patient pays first and then receives reimbursement in Shanghai after presenting documents.

But the staff found that the medical bill submitted by Liang was a different color than that of another patient being treated at the same hospital. A later investigation found Liang Maodi never went to the Suzhou hospital and all of her documents were fake.

Then officials reviewed all previous medical bills of Liang Maodi and found she had received 13 reimbursements for treatment at three hospitals in Suzhou in recent years. Her niece went to claim all the reimbursements in Shanghai, as Liang Maodi lives in Suzhou.

All the medical documents had similar handwriting, and officials at the medical insurance center said they were well-faked. It was by chance they detected the crime: Liang Meijuan submitted the documents the same day another patient presented papers from the same hospital.

During the police investigation, Liang Maodi and Liang Meijuan confessed the fraud.

Liang Maodi said in the hearing that she learned how to game the system from a "doctor" surnamed Xu during a tonic exhibition in Suzhou.

The "doctor" taught her how to cheat the system and offered her all the fake medical documents. She said she gave 130,000 yuan of the 200,000 yuan she fraudulently collected to Xu as commission.

Officials said the court will announce the sentence soon.


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