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    Home > Medical News > Latest Medical News > The National Medical Security Administration exposed typical cases in the first phase of 2023

    The National Medical Security Administration exposed typical cases in the first phase of 2023

    • Last Update: 2023-02-02
    • Source: Internet
    • Author: User
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    1.
    Tianjin Tianjin Pharmaceutical Group Ma Guang Medical Investment Management Co.
    , Ltd.
    Fangda Building Outpatient Department illegally used medical insurance funds
     
    In April 2022, the Tianjin Municipal Medical Security Bureau found during the verification of the clues of the report and complaint that the outpatient department of Fangda Building of Tianjin Pharmaceutical Group Ma Guang Medical Investment Management Co.
    , Ltd.
    was suspected of using medical insurance funds
    in violation of regulations 。 Law enforcement personnel inquired into the medical insurance settlement information of the outpatient department through the Tianjin Medical Security Information Platform for data analysis, on-site inspection, interviewing relevant personnel, consulting materials, etc.
    , and found that the outpatient department had collusive diagnosis and treatment items, included medical expenses not covered by the medical insurance fund into the settlement of the medical insurance fund, and other violations of laws and regulations that caused losses to the medical insurance fund, involving the illegal use of the medical insurance fund 605,089.
    17 yuan
    。 According to the Administrative Punishment Law of the People's Republic of China and the Regulations on the Supervision and Administration of the Use of Medical Security Funds, the local medical insurance department handled the following results: 1.
    Order the outpatient department to return the medical insurance fund used in violation of laws and regulations; 2.
    A fine of 579,344.
    97 yuan was imposed on the outpatient department for violations of laws and regulations; 3.
    The outpatient department was ordered to rectify
    within a time limit.
    At present, the loss of 605089.
    17 yuan of the medical insurance fund has been fully recovered, and the fine of 579344.
    97 yuan has been fully handed over
    .
     
    2.
    The case of illegal use of medical insurance funds by Chengde Hospital of Traditional Chinese Medicine in Hebei Province
     
    In June 2021, the Chengde Municipal Medical Security Bureau of Hebei Province found that the Chengde Municipal Medical Hospital was suspected of using medical insurance funds in violation of regulations when conducting a grid inspection of the use of medical insurance funds
    in designated medical institutions in the city.
    After investigation, the hospital had violations such as medical expenses beyond the scope of medical insurance fund payment from January 2020 to December 2021, such as including medical insurance fund settlement, serial exchange of diagnosis and treatment items, and repeated inspection, involving the illegal use of medical insurance fund 5,115,555.
    40 yuan
    .
    According to the Agreement on Medical Services of Designated Medical Institutions in Chengde City, the local medical insurance department handled the following results: 1.
    Order the hospital to return the medical insurance fund used in violation of the law; 2.
    Interview the relevant person in charge of the hospital and order the hospital to rectify
    within a time limit.
    At present, the loss of 5,115,555.
    40 yuan of the medical insurance fund has been fully recovered
    .
     
    3.
    The case of illegal use of medical insurance funds by Yijin Holuo Banner Xinyuan Hospital in Ordos City, Inner Mongolia Autonomous Region
     
    In August 2021, the Ordos Municipal Medical Security Bureau of Inner Mongolia Autonomous Region found that Yijin Holuo Banner Xinyuan Hospital was suspected of using medical insurance funds
    in violation of regulations during an on-site inspection of the use of medical insurance funds in designated medical institutions in the city.
    After investigation, Yijin Holuoqi Xinyuan Hospital had violations of laws and regulations such as excessive diagnosis and treatment and excessive standard charges in violation of diagnosis and treatment standards from January 2020 to September 2021, involving the illegal use of medical insurance funds of 937,780.
    72 yuan (of which 856,670.
    92 yuan was not allocated to the medical insurance fund and 81,109.
    80 yuan was allocated to the medical insurance fund).

    。 According to the Regulations on the Supervision and Administration of the Use of Medical Security Funds and the Service Agreement of Designated Medical Institutions of Ordos Basic Medical Insurance, the local medical insurance department handled the following results: 1.
    Refusal to pay 856,670.
    92 yuan of the medical insurance fund used by the hospital in violation of laws and regulations; 2.
    Order the hospital to return the loss of the medical insurance fund caused by 81,109.
    80 yuan, and impose a fine of 162,219.
    60 yuan twice the amount of the loss; 3.
    Order the hospital to rectify within a time limit and interview the legal person and main person in charge of the hospital; 4.
    Order the hospital to suspend the qualification of Ji Moumou, the attending physician of internal medicine, for medical insurance services for 6 months
    .
    At present, the loss of 81,109.
    80 yuan of the medical insurance fund has been fully recovered, and the fine of 162,219.
    60 yuan has been fully paid
    .
     
    4.
    The case of Binxian Furen Hospital Co.
    , Ltd.
    in Harbin, Heilongjiang Province using medical insurance funds in violation of laws and regulations
     
    In 2020, the Harbin Medical Security Bureau of Heilongjiang Province received a tip that Heilongjiang Furen Hospital Co.
    , Ltd.
    (now known as Binxian Furen Hospital Co.
    , Ltd.
    ) was suspected of fraudulently obtaining medical insurance funds
    .
    After investigation, the hospital had 16 violations of laws and regulations, such as collecting bedside blood glucose and collecting peripheral blood collection, and collecting spectrum electrocardiograms for serial exchange items, involving the illegal use of medical insurance funds of 4,684,083.
    92 yuan (of which, it was determined that fraud defrauded the medical insurance fund of 89,584.
    60 yuan).

    。 According to the Social Insurance Law of the People's Republic of China and the Service Agreement of Penn County Medical Security Designated Medical Institutions, the local medical insurance department has handled the following results: 1.
    The qualification of the hospital's medical insurance designated medical institutions is canceled; 2.
    Order the hospital to return the medical insurance fund used in violation of laws and regulations, and impose a five-fold administrative fine of 447,923.
    00 yuan
    on the hospital for fraudulently obtaining 89,584.
    60 yuan from the medical insurance fund.
    The Penn County Public Security Bureau has taken criminal compulsory measures
    against the persons involved in criminal offenses in the court.
    At present, the lost medical insurance fund of 4,684,083.
    92 yuan has been fully recovered, and the administrative fine of 447,923.
    00 yuan has been fully paid
    .
     
    5.
    The case of illegal use of medical insurance funds by Huai'an Hospital in Huai'an City, Jiangsu Province
     
    In July 2022, the Jiangsu Provincial Medical Security Bureau found in the supervision and inspection of the use of medical insurance funds of designated medical institutions in the province that from January 2020 to March 2022, Huai'an Hospital had violations of laws and regulations, such as admission of patients admitted to the hospital with low standards, charges without medical advice, charges without reports, over-standard charges, duplicate charges, and fees for serial projects, involving the illegal use of medical insurance funds of 3,883,400.
    00 yuan
    。 In accordance with the Regulations on the Supervision and Administration of the Use of Medical Security Funds, the Measures for Regulating the Discretionary Power of Administrative Penalties for the Supervision and Management of the Use of Medical Security Funds, and other relevant provisions, in August 2022, the local medical insurance department handled the following results: 1.
    Recover the medical insurance fund used by the hospital in violation of laws and regulations, and impose an administrative fine of 1 times the amount of the violation and violations; 2.
    Order the hospital to rectify violations of laws and regulations within a time limit; 3.
    List the hospital as generally untrustworthy in medical insurance; 4.
    Transfer the court's relevant case leads to the local discipline inspection commission and supervision commission
    .
    At present, the lost medical insurance fund of 3,883,400.
    00 yuan has been fully recovered, and the administrative fine of 3,883,400.
    00 yuan has been fully handed over
    .
     
    6.
    The case of the Second People's Hospital of Pingyang County, Wenzhou City, Zhejiang Province using medical insurance funds in violation of laws and regulations
     
    In August 2021, when the Wenzhou Municipal Medical Security Bureau of Zhejiang Province conducted an on-site inspection of the use of the medical insurance fund of the Second People's Hospital of Pingyang County, it found that between January 1, 2020 and June 30, 2021, the hospital had repeated charges, decomposed charges, over-standard charges, over-the-standard charges, medication beyond the scope of medical insurance restrictions, and included settlement fees that did not belong to the medical insurance fund into the settlement, resulting in a loss of 2,368,647.
    00 yuan
    to the medical insurance fund 。 According to the Regulations on the Supervision and Administration of the Use of Medical Security Funds, the Measures for Regulating the Discretionary Power of Administrative Penalties for the Supervision and Management of the Use of Medical Security Funds, and the Service Agreement of Designated Medical Institutions of Pingyang County Basic Medical Insurance, the local medical insurance department handled the following results: 1.
    Recover the medical insurance fund used by the hospital in violation of laws and regulations, and impose a fine of 139,571.
    00 yuan on the amount involved in the violation of laws and regulations after the implementation of the Regulations on the Supervision and Administration of the Use of Medical Security Fund; 2.
    Notify the supervision department
    of the county discipline inspection commission of the information involved in the case 。 At present, the lost medical insurance fund of 2368647.
    00 yuan has been fully recovered, and the administrative fine of 139571.
    00 yuan has been fully paid
    .
     
    7.
    The case of illegal use of medical insurance funds by the Tongbei Community Health Service Center in Zhangcheng District, Zhangzhou City, Fujian Province
     
    In June 2022, the Fujian Provincial Medical Security Monitoring and Electronic Settlement Center found that the hemophilia special clinic of the Tongbei Community Health Service Center in Zhangzhou City was suspected of using medical insurance funds
    in violation of regulations.
    The Zhangzhou Municipal Medical Security Bureau immediately organized an inspection team to enter the hospital to carry out verification, and found that the hospital had problems such as duplicate charges, including non-medical insurance expenses in medical insurance settlement, and inconsistencies in the distribution of drugs and consumables, involving illegal or default use of the medical insurance fund of 2,983,806.
    77 yuan
    。 According to the Regulations on the Supervision and Administration of the Use of Medical Security Funds and the 2021 Zhangzhou Basic Medical Insurance Contract Medical Institution Service Agreement, the local medical insurance department handled the following results: 1.
    Deduct the repeated deductions of daily audits and recover the amount of 2,815,703.
    80 yuan in violation of laws and regulations; 2.
    Impose administrative fines on the hospital's duplicate charges and the inclusion of non-medical insurance expenses in medical insurance settlement; 3.
    Order the hospital to immediately rectify; 4.
    Suspend the medical insurance service payment qualification of physician Chen Moumou for 6 months, and suspend the medical insurance service payment qualification of physician Guo Moumou and pharmacist Lin Moumou for 3 months
    .
    At present, the lost medical insurance fund of 2815703.
    80 yuan has been fully recovered, and all administrative fines have been paid
    .
     
    8.
    The case of illegal use of medical insurance funds by Leping People's Hospital of Jingdezhen City, Jiangxi Province
     
    In October 2021, the Jingdezhen Municipal Medical Security Bureau of Jiangxi Province, based on the clues handed over by the Jiangxi Provincial Medical Insurance Bureau, further investigated and found that Leping People's Hospital had violations of laws and regulations such as lowering admission standards, excessive diagnosis and treatment, and decomposing project charges, involving the illegal use of medical insurance funds of 5,608,022.
    05 yuan
    。 According to the Regulations on the Supervision and Administration of the Use of Medical Security Funds, the Implementation Rules for the Discretionary Power of Administrative Penalties for the Supervision of Jiangxi Medical Security Funds (for Trial Implementation), and the Medical Insurance Service Agreement for Designated Medical Institutions in Jingdezhen City, the local medical insurance department handled the following results: 1.
    Recover the medical insurance fund used by the hospital in violation of laws and regulations, and impose an administrative fine of 1,682,000.
    00 yuan on the hospital's violations of laws and regulations; 2.
    Interview the relevant person in charge of the hospital and order immediate rectification, and put the hospital on the key supervision list
    。 At present, the lost medical insurance fund of 5,608,022.
    05 yuan has been fully recovered, and the administrative fine of 1,682,000.
    00 yuan has been fully paid
    .
     
    9.
    The case of illegal use of medical insurance funds by Tunchang Minfu Hospital in Tunchang County, Hainan Province
     
    In November 2021, the Hainan Provincial Medical Security Bureau conducted a special inspection
    of the settlement of the medical insurance fund of Tunchang Minfu Hospital in Tunchang County from January 1, 2020 to September 30, 2021.
    Through big data analysis and on-site verification by medical experts, the inspection team found that the hospital had violations of laws and regulations such as over-standard charges, duplicate charges, cascading charges, and low-standard hospitalization, involving the illegal use of medical insurance funds of 1,376,110.
    73 yuan
    。 According to the Social Insurance Law of the People's Republic of China, the Regulations on the Supervision and Administration of the Use of Medical Security Fund, the Rules for the Application of Discretionary Administrative Penalties for the Supervision and Management of the Use of Medical Security Fund in Hainan Province, and the Medical Service Agreement of Designated Medical Institutions of Basic Medical Insurance of Hainan Province, the local medical insurance department handled the following results: 1.
    Order the hospital to return the medical insurance fund used in violation of laws and regulations, and impose a fine of 2,064,166.
    10 yuan 1.
    5 times the amount of violations of laws and regulations; 2.
    Order the hospital to rectify within a time limit; 3.
    Give a warning to the court and report criticism within the county; 4.
    Starting from April 1, 2022, the hospital's medical services involving the use of medical insurance funds will be suspended for 2 months
    .
    At present, the lost medical insurance fund of 1,376,110.
    73 yuan has been fully recovered, and the administrative fine of 2,064,166.
    10 yuan has been fully paid
    .
     
    10.
    The case of illegal use of medical insurance funds by Renai Hospital of Yushu City, Yushu Prefecture, Qinghai Province
     
    In September 2021, during an on-site inspection of Yushu Renai Hospital in Yushu City, the Medical Security Bureau of Qinghai Province found that between January 2020 and August 2021, the hospital had repeated charges, over-medical insurance limited payments, over-standard charges, serial charges, bed-hanging hospitalizations, false prescription of drug quantities, and illegal price increases, involving the illegal use of medical insurance funds of 1,860,243.
    93 yuan
    。 According to the Regulations on the Supervision and Administration of the Use of Medical Security Funds and the Service Agreement of Designated Medical Institutions of Qinghai Province, the local medical insurance department handled the following results: 1.
    Recover the medical insurance fund used by the hospital in violation of laws and regulations, and impose a fine of 277805.
    78 yuan; 2.
    The hospital's medical insurance service agreement will be terminated from March 30, 2022, and at the same time, no re-application for medical insurance designated service qualifications will be allowed within 3 years, and the province will implement it in a coordinated manner
    .
    At present, the loss of 1,860,243.
    93 yuan of the medical insurance fund has been fully recovered, and the fine of 277,805.
    78 yuan has been fully paid
    .
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