The medical insurance flight inspection found that the phenomenon of exceeding the medical insurance payment limit and other phenomena collectively "checked the pulse" to find the problem

　　"Urine sediment quantitative examination is usually suitable for patients with urology, nephrology, obstetrics and renal disease, but all the patients admitted to the hospital have done this examination.
Some patients have no indication and are suspected of excessive examination, involving 112,334 person-times and suspected violations.
The amount is 2,246,740 yuan.
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" On the evening of August 26, the conference room of the Second Affiliated Hospital of Kunming Medical University in Yunnan Province was brightly lit, and the representatives of each group of the National Medical Insurance Flight Inspection Team reported the problems found during the inspection one by one
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Such intensive seminars have been held for three consecutive days since the unannounced inspection team settled in the inspected medical institution
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The first representative of the intracardiac group to take the stage put the inspection summary of the day on the big screen.
As you can see, the suspected problems found by this group mainly included unindicated inspections such as quantitative urine sediment, the level of care did not lower the level of care, and the repeated collection was complicated.
The use of special surgical knives, DRG grouping is highly dependent on diagnosis, etc.
The number of people involved, the amount and the policy basis are clear at a glance
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General anesthesia is used for patients with paronychia, and total hip replacement is charged for hemiarthroplasty.
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In addition to the common problems identified by big data, the representative of the orthopaedic department also introduced the group's findings after reviewing more than 300 medical records.
A series of personality problems: "For example, the patient with medical record No.
90456015, whose surgical records show that 2 boxes of allogeneic bone were used, but the billing and labeling show that there are 3 boxes, there are obvious discrepancies, involving a suspected illegal amount of 3,740 yuan
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" Here At the seminar, "problem" became the most frequently occurring keyword
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While pointing out the problems, the delegates will also share the experience of the group and fully communicate about the difficulties and doubts in the inspection
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"According to the Yunnan Provincial Drug List, 'Dragon Ball Ointment', 'Ginkgo Leaf', 'Calcium Carbonate D3' and other drugs are limited to outpatient use, but we found that some inpatients in the hospital also used these drugs, and the medical insurance settlement was made
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" Comprehensive The representative of the group said, "In addition, we noticed that more than 1,100 insured personnel in this hospital were re-admitted for the same disease within one day after being discharged from the hospital.
It is suspected that there is a problem of decomposition of hospitalization, and I would like to hear everyone's opinions.

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" "This issue involves a relatively large amount of money, and it is necessary to grasp it securely to ensure that there is evidence to back it up
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" "You can communicate with the hospital again for further investigation
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"Other representatives made suggestions one after another
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The self-examination of medical prices has gone through the motions, and some medical staff are not aware of the supervision and management regulations for the use of medical insurance funds and medical insurance policies; suspected of illegal use of unselected drugs and illegal offline purchases ; suspected of drug spending.
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At the seminar, representatives of the policy team, the centralized procurement team, and the financial team reported successively
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The relevant person in charge of the unannounced inspection team told reporters that the inspection of this designated medical institution is coming to an end.
The main problem is that it involves such categories as exceeding medical insurance payment limits, excessive inspections, repeated charges, and exceeding standard
charges .
Follow-up work will be done to check suspicious points and fix evidence to ensure that the inspection results can stand the test
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The person in charge said that since the official implementation of the first regulations in the field of medical insurance in China in May 2021, the degree of standardization of the supervision and management of the use of medical insurance funds has been continuously improved.
The working mechanism of finding clues to problems in the process, forming a joint force of work, and giving full play to the deterrent effect
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After the meeting, the representatives of each group found the corresponding hospital contact person and gave face-to-face feedback on the initial problems
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The person in charge of the Second Affiliated Hospital of Kunming Medical University said that a group meeting of the team members and the heads of each department had been held that night to check carefully.
And study the rectification plan, "For the problems that have been confirmed, it is necessary to make immediate changes, and the responsible persons involved should be dealt with resolutely
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"(Zuo Handi, the website of the Central Commission for Discipline Inspection and State Supervision Commission) Standard Hospital for Drug and Disease Procurement