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On August 23, the 2022 National Medical Security Fund Flight Inspection Yunnan Kick-off Meeting was held
in Kunming.
The National Medical Insurance Flight Inspection Team, composed of the National Medical Insurance Bureau, the staff of Henan Province, and relevant experts, will carry out a 10-day "comprehensive physical examination"
around the implementation of the decision-making and deployment of the Party Central Committee by local medical institutions.
in Kunming.
The National Medical Insurance Flight Inspection Team, composed of the National Medical Insurance Bureau, the staff of Henan Province, and relevant experts, will carry out a 10-day "comprehensive physical examination"
around the implementation of the decision-making and deployment of the Party Central Committee by local medical institutions.
Two days later, on August 25, the website of the Central Commission for Discipline Inspection and the State Supervision Commission published an article entitled "Medical Insurance Flight Inspection Stationed in Yunnan On the First Day of Inspection, I Did Not Miss Any Doubts", revealing more details
of the flight inspection.
of the flight inspection.
It is reported that this flight inspection, as large as the "cost list, the first page of the case", as small as the "screw, fusion", the inspection team strictly grasped the inspection points and risk points, and gave strict review
to every possible violation of laws and regulations.
to every possible violation of laws and regulations.
According to public reports, since July this year, the Flight Inspection of the National Medical Security Fund has been carried out
in many provinces.
Industry insiders pointed out that such as orthopedics, cardiology, hemodialysis, tumors, such high-priced drugs, high-value consumables use more, large profit margins, more likely to appear violations of laws and regulations, this "two and a half years of reverse inspection" flight inspection, focusing on key departments, key areas, key links, from the details and strict violations of the law exposed to the "sunshine", collusion projects, illegal diagnosis and treatment, fraud and insurance fraud, drug kickbacks and other behaviors will become the place where the regulatory sword
。
in many provinces.
Industry insiders pointed out that such as orthopedics, cardiology, hemodialysis, tumors, such high-priced drugs, high-value consumables use more, large profit margins, more likely to appear violations of laws and regulations, this "two and a half years of reverse inspection" flight inspection, focusing on key departments, key areas, key links, from the details and strict violations of the law exposed to the "sunshine", collusion projects, illegal diagnosis and treatment, fraud and insurance fraud, drug kickbacks and other behaviors will become the place where the regulatory sword
。
Flight inspection "reverse check for two and a half years"
Don't miss every "detail"
The medical insurance fund is the people's "medical treatment money" and "life-saving money", and the safety of the fund involves the vital interests
of the broad masses of the people.
On May 31, the National Medical Insurance Bureau issued the "2022 Annual Medical Security Fund Flight Inspection Work Plan", which not only officially announced the official start of a new round of medical insurance fund flight inspection work, but also framed the use
of medical insurance funds since January 1, 2020.
of the broad masses of the people.
On May 31, the National Medical Insurance Bureau issued the "2022 Annual Medical Security Fund Flight Inspection Work Plan", which not only officially announced the official start of a new round of medical insurance fund flight inspection work, but also framed the use
of medical insurance funds since January 1, 2020.
Retrospectively looking back at the flight inspection from now on, "two and a half years of backward inspection" sends a very strong regulatory signal
.
.
In accordance with the deployment of the "Work Plan", the flight inspection team focused on the medical service behaviors and medical expenses included in the scope of payment by the medical security fund in the fields of hemodialysis and high-value medical consumables (orthopedics, cardiology) of designated medical institutions (including local receipt of settlement fees for medical personnel in different places across provinces), the performance of service agreements and fee review and settlement payments of medical insurance agencies, and the fraudulent acquisition of medical insurance funds through forgery of medical-related materials and fictitious medical service projects
。
。
On July 8, the Heilongjiang Launch Meeting of the National Medical Insurance Fund Flight Inspection was held in Harbin, marking the official launch
of the 2022 National Medical Insurance Fund Flight Inspection.
Subsequently, in accordance with the unified deployment of the National Medical Insurance Bureau, various localities have launched the flight inspection of the medical insurance fund in 2022:
of the 2022 National Medical Insurance Fund Flight Inspection.
Subsequently, in accordance with the unified deployment of the National Medical Insurance Bureau, various localities have launched the flight inspection of the medical insurance fund in 2022:
On July 11, the National Medical Security Fund Flight Inspection Jilin Province Kick-off Meeting was held in Changchun City;
On July 25, the National Medical Security Fund Flight Inspection Guangxi Kick-off Meeting was held in Yulin, Guangxi;
On July 26, the National Medical Security Fund Flight Inspection Hebei Kick-off Meeting was held in Shijiazhuang, Hebei Province;
On July 28, the National Medical Security Fund Flight Inspection Inner Mongolia Kick-off Meeting was held in Xilingol League, Inner Mongolia;
On August 2, the National Medical Security Fund Flight Inspection Jiangxi Kick-off Meeting was held in Ganzhou, Jiangxi;
On August 10, the National Medical Security Fund Flight Inspection Jiangsu Kick-off Meeting was held in Nanjing, Jiangsu Province;
On August 15, the National Medical Security Fund Flight Inspection Fujian Kick-off Meeting was held in Fuzhou, Fujian Province;
.
.
.
.
.
.
.
.
.
.
.
What makes the industry quite concerned is: how is the medical insurance flight inspection checked? An article published by the Central Commission for Discipline Inspection on August 25 revealed the details
of the examination of the "medical-orthopedic group" stationed in the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
of the examination of the "medical-orthopedic group" stationed in the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
The article mentioned that on the first day of officially entering the designated medical institutions under inspection, the task of the flight inspection team was to "check the use of the medical insurance fund of the hospital for two and a half years"
.
.
It is reported that in terms of inspection content, this inspection work is not only comprehensive, but also very meticulous:
"Look at the list of expenses, the first page of the medical case, look at the surgical records, look at the consumables label, find loopholes in the comparison, and find doubts
.
"
.
"
"6 nails, 1 fuser, 2 connecting rods.
.
.
With the assistance of doctors in the hospital, Li Jun (a cadre of the Fund Supervision Department of the National Medical Insurance Administration) opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
”
.
.
With the assistance of doctors in the hospital, Li Jun (a cadre of the Fund Supervision Department of the National Medical Insurance Administration) opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
”
"There is a description in the surgical record, why was it not charged in the end?"
"The diagnosis on the first page of the case includes abnormal coagulation function, but the corresponding treatment is not reflected in the diagnosis and
treatment record.
"
treatment record.
"
"Are you involved in the follow-up surgery?" "How do I determine the consumables actually used during surgery after surgery?"
Combined with the suspicious points found in the examination, each team invited doctors and nurses in different professional fields into the conference room to make targeted inquiries in order to carry out follow-up research and judgment.
.
.
.
.
It is not difficult to feel from this that this round of medical insurance flight inspection is undoubtedly prepared, and this flight inspection team has also set up a comprehensive policy guarantee group, a medical group (under the comprehensive group, an orthopedic group, an intracardiac group), a collection group, an information group, a financial group and other groups, fully grasping the risk problem links and comprehensively carrying out detailed inspections
.
.
Building a strong sense of rational drug use, ensuring the clinical use of centralized procurement products, keeping the safety of medical insurance funds, and strengthening the supervision of medical insurance funds have always been highly valued
by pharmaceutical supervision.
The market generally believes that under the meticulous inspection of the staff of the National Medical Insurance Flight Inspection Team, any fraudulent insurance fraud will be exposed at a glance!
by pharmaceutical supervision.
The market generally believes that under the meticulous inspection of the staff of the National Medical Insurance Flight Inspection Team, any fraudulent insurance fraud will be exposed at a glance!
The "five major mechanisms" form a joint force of supervision
Legal compliance is a top priority
Since the establishment of the National Medical Insurance Bureau in 2018, in order to effectively solve the problem of irregular and even fraudulent use of medical insurance funds, increase the intensity of cracking down on insurance fraud, and establish and improve a multi-form combination of medical insurance fund inspection system, including flight inspection, daily inspection, special inspection, key inspection, expert review, etc
.
.
Among them, the medical insurance flight inspection is a sharp sword
to ensure the safety of the medical insurance fund.
On July 22, 2022, at the Press Conference held by the National Health commission on the progress of deepening medical reform since the 18th National Congress of the Communist Party of China, Li Shuchun, deputy director of the Department of Pharmaceutical Management of the National Medical Insurance Bureau, introduced that by the end of 2021, the National Medical Insurance Bureau had carried out a total of 160 flight inspections, inspected 336 designated medical institutions, and found more than 3 billion yuan
of funds suspected of violating the law.
to ensure the safety of the medical insurance fund.
On July 22, 2022, at the Press Conference held by the National Health commission on the progress of deepening medical reform since the 18th National Congress of the Communist Party of China, Li Shuchun, deputy director of the Department of Pharmaceutical Management of the National Medical Insurance Bureau, introduced that by the end of 2021, the National Medical Insurance Bureau had carried out a total of 160 flight inspections, inspected 336 designated medical institutions, and found more than 3 billion yuan
of funds suspected of violating the law.
In order to ensure that the people's "life-saving money" is not "Tang monk meat" and is defrauded, the National Medical Insurance Bureau will conduct several rounds of medical insurance flight inspections
every year.
In 2021 alone, it was found that 503 million yuan
of medical insurance funds were suspected of illegal use.
every year.
In 2021 alone, it was found that 503 million yuan
of medical insurance funds were suspected of illegal use.
On May 19, 2022, the National Medical Insurance Bureau issued the "Announcement on the Flight Inspection of the Medical Insurance Fund in 2021"
.
The announcement pointed out that in 2021, the National Medical Insurance Bureau and others will conduct flight inspections
of the use of medical insurance funds in 68 designated medical institutions (29 tertiary hospitals, 15 secondary hospitals, 22 first-level hospitals, and 2 medical and nursing institutions) in 29 provinces across the country.
The inspection found that the designated medical institutions under inspection had medical insurance management problems and problems such as repeated charges, excessive standard charges, decomposition project charges, excessive diagnosis and treatment in violation of diagnosis and treatment norms, excessive inspection, etc.
, and were suspected of using the medical insurance fund of 503 million yuan
in violation of laws and regulations.
.
The announcement pointed out that in 2021, the National Medical Insurance Bureau and others will conduct flight inspections
of the use of medical insurance funds in 68 designated medical institutions (29 tertiary hospitals, 15 secondary hospitals, 22 first-level hospitals, and 2 medical and nursing institutions) in 29 provinces across the country.
The inspection found that the designated medical institutions under inspection had medical insurance management problems and problems such as repeated charges, excessive standard charges, decomposition project charges, excessive diagnosis and treatment in violation of diagnosis and treatment norms, excessive inspection, etc.
, and were suspected of using the medical insurance fund of 503 million yuan
in violation of laws and regulations.
In addition to routine flight inspections, the National Medical Insurance Bureau also encourages the reporting of illegal use of medical insurance funds, and the state and medical insurance departments at all levels have established a reward system for whistleblowing, opening up telephone, WeChat, letter and other reporting channels
.
.
In the Measures for Rewarding Illegal Use of Medical Security Funds (Draft for Solicitation of Comments), which was issued in July this year, the scope of rewards for reporting was extended from fraud and insurance fraud to all illegal use of medical insurance funds, and the reward standard was greatly increased, and the maximum reward was raised from 100,000 to 200,000 yuan
.
.
In March 2022, the National Medical Insurance Bureau conducted a flight inspection of Wuhan Tongji Hospital based on the tip-off clues, and after investigation, it was found that between January 2017 and September 2020, Tongji Hospital had the problem of collusion and false recording of high-value medical consumables in orthopedics, and defrauded the medical insurance fund of 23.
34 million yuan
.
According to relevant regulations, Tongji Hospital was fined more than 59 million yuan and suspended the medical services used by the medical insurance fund for 8 months in the orthopedic department
.
34 million yuan
.
According to relevant regulations, Tongji Hospital was fined more than 59 million yuan and suspended the medical services used by the medical insurance fund for 8 months in the orthopedic department
.
In recent years, the National Medical Insurance Bureau has done a lot of work in maintaining the safety of the medical insurance fund, including a full-coverage daily supervision and inspection mechanism, a "double random, one open" flight inspection mechanism, a multi-departmental comprehensive supervision and joint disciplinary action mechanism, a reporting reward mechanism for the whole people, and a public exposure mechanism
.
At the same time, it has also established and improved the long-term supervision mechanism of medical insurance funds, and further tightened the cage
of the medical insurance fund supervision system.
.
At the same time, it has also established and improved the long-term supervision mechanism of medical insurance funds, and further tightened the cage
of the medical insurance fund supervision system.
The industry believes that the safety of medical insurance funds is related to the health and sustainable development of the medical security system, with the continuous deepening of medical insurance supervision, the use of medical insurance funds will be more transparent and standardized, whether it is medical institutions or medical equipment companies, they must abandon the fluke psychology and keep the bottom line
of legal compliance.
of legal compliance.
On August 23, the 2022 National Medical Security Fund Flight Inspection Yunnan Kick-off Meeting was held
in Kunming.
The National Medical Insurance Flight Inspection Team, composed of the National Medical Insurance Bureau, the staff of Henan Province, and relevant experts, will carry out a 10-day "comprehensive physical examination"
around the implementation of the decision-making and deployment of the Party Central Committee by local medical institutions.
in Kunming.
The National Medical Insurance Flight Inspection Team, composed of the National Medical Insurance Bureau, the staff of Henan Province, and relevant experts, will carry out a 10-day "comprehensive physical examination"
around the implementation of the decision-making and deployment of the Party Central Committee by local medical institutions.
Two days later, on August 25, the website of the Central Commission for Discipline Inspection and the State Supervision Commission published an article entitled "Medical Insurance Flight Inspection Stationed in Yunnan On the First Day of Inspection, I Did Not Miss Any Doubts", revealing more details
of the flight inspection.
of the flight inspection.
It is reported that this flight inspection, as large as the "cost list, the first page of the case", as small as the "screw, fusion", the inspection team strictly grasped the inspection points and risk points, and gave strict review
to every possible violation of laws and regulations.
to every possible violation of laws and regulations.
According to public reports, since July this year, the Flight Inspection of the National Medical Security Fund has been carried out
in many provinces.
Industry insiders pointed out that such as orthopedics, cardiology, hemodialysis, tumors, such high-priced drugs, high-value consumables use more, large profit margins, more likely to appear violations of laws and regulations, this "two and a half years of reverse inspection" flight inspection, focusing on key departments, key areas, key links, from the details and strict violations of the law exposed to the "sunshine", collusion projects, illegal diagnosis and treatment, fraud and insurance fraud, drug kickbacks and other behaviors will become the place where the regulatory sword
。
Pharmaceuticalsin many provinces.
Industry insiders pointed out that such as orthopedics, cardiology, hemodialysis, tumors, such high-priced drugs, high-value consumables use more, large profit margins, more likely to appear violations of laws and regulations, this "two and a half years of reverse inspection" flight inspection, focusing on key departments, key areas, key links, from the details and strict violations of the law exposed to the "sunshine", collusion projects, illegal diagnosis and treatment, fraud and insurance fraud, drug kickbacks and other behaviors will become the place where the regulatory sword
。
Flight inspection "reverse check for two and a half years"
Flight inspection "reverse check for two and a half years" Don't miss every "detail"
Don't miss every "detail" The medical insurance fund is the people's "medical treatment money" and "life-saving money", and the safety of the fund involves the vital interests
of the broad masses of the people.
On May 31, the National Medical Insurance Bureau issued the "2022 Annual Medical Security Fund Flight Inspection Work Plan", which not only officially announced the official start of a new round of medical insurance fund flight inspection work, but also framed the use
of medical insurance funds since January 1, 2020.
of the broad masses of the people.
On May 31, the National Medical Insurance Bureau issued the "2022 Annual Medical Security Fund Flight Inspection Work Plan", which not only officially announced the official start of a new round of medical insurance fund flight inspection work, but also framed the use
of medical insurance funds since January 1, 2020.
Retrospectively looking back at the flight inspection from now on, "two and a half years of backward inspection" sends a very strong regulatory signal
.
.
In accordance with the deployment of the "Work Plan", the flight inspection team focused on the medical service behaviors and medical expenses included in the scope of payment by the medical security fund in the fields of hemodialysis and high-value medical consumables (orthopedics, cardiology) of designated medical institutions (including local receipt of settlement fees for medical personnel in different places across provinces), the performance of service agreements and fee review and settlement payments of medical insurance agencies, and the fraudulent acquisition of medical insurance funds through forgery of medical-related materials and fictitious medical service projects
。
Medicine。
On July 8, the Heilongjiang Launch Meeting of the National Medical Insurance Fund Flight Inspection was held in Harbin, marking the official launch
of the 2022 National Medical Insurance Fund Flight Inspection.
Subsequently, in accordance with the unified deployment of the National Medical Insurance Bureau, various localities have launched the flight inspection of the medical insurance fund in 2022:
of the 2022 National Medical Insurance Fund Flight Inspection.
Subsequently, in accordance with the unified deployment of the National Medical Insurance Bureau, various localities have launched the flight inspection of the medical insurance fund in 2022:
On July 11, the National Medical Security Fund Flight Inspection Jilin Province Kick-off Meeting was held in Changchun City;
On July 25, the National Medical Security Fund Flight Inspection Guangxi Kick-off Meeting was held in Yulin, Guangxi;
On July 26, the National Medical Security Fund Flight Inspection Hebei Kick-off Meeting was held in Shijiazhuang, Hebei Province;
On July 28, the National Medical Security Fund Flight Inspection Inner Mongolia Kick-off Meeting was held in Xilingol League, Inner Mongolia;
On August 2, the National Medical Security Fund Flight Inspection Jiangxi Kick-off Meeting was held in Ganzhou, Jiangxi;
On August 10, the National Medical Security Fund Flight Inspection Jiangsu Kick-off Meeting was held in Nanjing, Jiangsu Province;
On August 15, the National Medical Security Fund Flight Inspection Fujian Kick-off Meeting was held in Fuzhou, Fujian Province;
.
.
.
.
.
.
. .
.
.
.
.
.
.
.
.
.
What makes the industry quite concerned is: how is the medical insurance flight inspection checked? An article published by the Central Commission for Discipline Inspection on August 25 revealed the details
of the examination of the "medical-orthopedic group" stationed in the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
Hospital Hospitalof the examination of the "medical-orthopedic group" stationed in the Second Affiliated Hospital of Kunming Medical University in Yunnan Province.
The article mentioned that on the first day of officially entering the designated medical institutions under inspection, the task of the flight inspection team was to "check the use of the medical insurance fund of the hospital for two and a half years"
.
.
It is reported that in terms of inspection content, this inspection work is not only comprehensive, but also very meticulous:
"Look at the list of expenses, the first page of the medical case, look at the surgical records, look at the consumables label, find loopholes in the comparison, and find doubts
.
"
.
"
"6 nails, 1 fuser, 2 connecting rods.
.
.
With the assistance of doctors in the hospital, Li Jun (a cadre of the Fund Supervision Department of the National Medical Insurance Administration) opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
”
.
.
With the assistance of doctors in the hospital, Li Jun (a cadre of the Fund Supervision Department of the National Medical Insurance Administration) opened the patient's X-ray and carefully checked the quantity and specifications of surgical consumables
.
”
"There is a description in the surgical record, why was it not charged in the end?"
"The diagnosis on the first page of the case includes abnormal coagulation function, but the corresponding treatment is not reflected in the diagnosis and
treatment record.
"
treatment record.
"
"Are you involved in the follow-up surgery?" "How do I determine the consumables actually used during surgery after surgery?"
Combined with the suspicious points found in the examination, each team invited doctors and nurses in different professional fields into the conference room to make targeted inquiries in order to carry out follow-up research and judgment.
.
.
.
.
It is not difficult to feel from this that this round of medical insurance flight inspection is undoubtedly prepared, and this flight inspection team has also set up a comprehensive policy guarantee group, a medical group (under the comprehensive group, an orthopedic group, an intracardiac group), a collection group, an information group, a financial group and other groups, fully grasping the risk problem links and comprehensively carrying out detailed inspections
.
.
Building a strong sense of rational drug use, ensuring the clinical use of centralized procurement products, keeping the safety of medical insurance funds, and strengthening the supervision of medical insurance funds have always been highly valued
by pharmaceutical supervision.
The market generally believes that under the meticulous inspection of the staff of the National Medical Insurance Flight Inspection Team, any fraudulent insurance fraud will be exposed at a glance!
by pharmaceutical supervision.
The market generally believes that under the meticulous inspection of the staff of the National Medical Insurance Flight Inspection Team, any fraudulent insurance fraud will be exposed at a glance!
The "five major mechanisms" form a joint force of supervision
The "five major mechanisms" form a joint force of supervision Legal compliance is a top priority
Legal compliance is a top priority Since the establishment of the National Medical Insurance Bureau in 2018, in order to effectively solve the problem of irregular and even fraudulent use of medical insurance funds, increase the intensity of cracking down on insurance fraud, and establish and improve a multi-form combination of medical insurance fund inspection system, including flight inspection, daily inspection, special inspection, key inspection, expert review, etc
.
.
Among them, the medical insurance flight inspection is a sharp sword
to ensure the safety of the medical insurance fund.
On July 22, 2022, at the Press Conference held by the National Health commission on the progress of deepening medical reform since the 18th National Congress of the Communist Party of China, Li Shuchun, deputy director of the Department of Pharmaceutical Management of the National Medical Insurance Bureau, introduced that by the end of 2021, the National Medical Insurance Bureau had carried out a total of 160 flight inspections, inspected 336 designated medical institutions, and found more than 3 billion yuan
of funds suspected of violating the law.
to ensure the safety of the medical insurance fund.
On July 22, 2022, at the Press Conference held by the National Health commission on the progress of deepening medical reform since the 18th National Congress of the Communist Party of China, Li Shuchun, deputy director of the Department of Pharmaceutical Management of the National Medical Insurance Bureau, introduced that by the end of 2021, the National Medical Insurance Bureau had carried out a total of 160 flight inspections, inspected 336 designated medical institutions, and found more than 3 billion yuan
of funds suspected of violating the law.
In order to ensure that the people's "life-saving money" is not "Tang monk meat" and is defrauded, the National Medical Insurance Bureau will conduct several rounds of medical insurance flight inspections
every year.
In 2021 alone, it was found that 503 million yuan
of medical insurance funds were suspected of illegal use.
every year.
In 2021 alone, it was found that 503 million yuan
of medical insurance funds were suspected of illegal use.
On May 19, 2022, the National Medical Insurance Bureau issued the "Announcement on the Flight Inspection of the Medical Insurance Fund in 2021"
.
The announcement pointed out that in 2021, the National Medical Insurance Bureau and others will conduct flight inspections
of the use of medical insurance funds in 68 designated medical institutions (29 tertiary hospitals, 15 secondary hospitals, 22 first-level hospitals, and 2 medical and nursing institutions) in 29 provinces across the country.
The inspection found that the designated medical institutions under inspection had medical insurance management problems and problems such as repeated charges, excessive standard charges, decomposition project charges, excessive diagnosis and treatment in violation of diagnosis and treatment norms, excessive inspection, etc.
, and were suspected of using the medical insurance fund of 503 million yuan
in violation of laws and regulations.
.
The announcement pointed out that in 2021, the National Medical Insurance Bureau and others will conduct flight inspections
of the use of medical insurance funds in 68 designated medical institutions (29 tertiary hospitals, 15 secondary hospitals, 22 first-level hospitals, and 2 medical and nursing institutions) in 29 provinces across the country.
The inspection found that the designated medical institutions under inspection had medical insurance management problems and problems such as repeated charges, excessive standard charges, decomposition project charges, excessive diagnosis and treatment in violation of diagnosis and treatment norms, excessive inspection, etc.
, and were suspected of using the medical insurance fund of 503 million yuan
in violation of laws and regulations.
In addition to routine flight inspections, the National Medical Insurance Bureau also encourages the reporting of illegal use of medical insurance funds, and the state and medical insurance departments at all levels have established a reward system for whistleblowing, opening up telephone, WeChat, letter and other reporting channels
.
.
In the Measures for Rewarding Illegal Use of Medical Security Funds (Draft for Solicitation of Comments), which was issued in July this year, the scope of rewards for reporting was extended from fraud and insurance fraud to all illegal use of medical insurance funds, and the reward standard was greatly increased, and the maximum reward was raised from 100,000 to 200,000 yuan
.
.
In March 2022, the National Medical Insurance Bureau conducted a flight inspection of Wuhan Tongji Hospital based on the tip-off clues, and after investigation, it was found that between January 2017 and September 2020, Tongji Hospital had the problem of collusion and false recording of high-value medical consumables in orthopedics, and defrauded the medical insurance fund of 23.
34 million yuan
.
According to relevant regulations, Tongji Hospital was fined more than 59 million yuan and suspended the medical services used by the medical insurance fund for 8 months in the orthopedic department
.
Regulations34 million yuan
.
According to relevant regulations, Tongji Hospital was fined more than 59 million yuan and suspended the medical services used by the medical insurance fund for 8 months in the orthopedic department
.
In recent years, the National Medical Insurance Bureau has done a lot of work in maintaining the safety of the medical insurance fund, including a full-coverage daily supervision and inspection mechanism, a "double random, one open" flight inspection mechanism, a multi-departmental comprehensive supervision and joint disciplinary action mechanism, a reporting reward mechanism for the whole people, and a public exposure mechanism
.
At the same time, it has also established and improved the long-term supervision mechanism of medical insurance funds, and further tightened the cage
of the medical insurance fund supervision system.
.
At the same time, it has also established and improved the long-term supervision mechanism of medical insurance funds, and further tightened the cage
of the medical insurance fund supervision system.
The industry believes that the safety of medical insurance funds is related to the health and sustainable development of the medical security system, with the continuous deepening of medical insurance supervision, the use of medical insurance funds will be more transparent and standardized, whether it is medical institutions or medical equipment companies, they must abandon the fluke psychology and keep the bottom line
of legal compliance.
Enterprise enterprise of legal compliance.
