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Recently, the official website of the National Health Commission released the notice of the "Evaluation Standards for Tertiary Hospitals (2022 Edition)" (hereinafter referred to as the "Standards") and its implementation rules
.
It is understood that the "Standards" consists of 107 sections in 3 parts, setting 364 standards and monitoring indicators
.
On the whole, the Standards pay close attention to the illegal acts
of hospitals in illegal procurement and malicious insurance fraud.
.
It is understood that the "Standards" consists of 107 sections in 3 parts, setting 364 standards and monitoring indicators
.
On the whole, the Standards pay close attention to the illegal acts
of hospitals in illegal procurement and malicious insurance fraud.
According to incomplete statistics on information published by the state and local discipline inspection and supervision departments, since the beginning of this year, more than 50 hospital presidents and secretaries have been investigated
.
Most of these personnel seriously violated discipline and law due to accepting kickbacks, using their positions to seek benefits for others, etc.
, involving drug admission and sales
.
.
Most of these personnel seriously violated discipline and law due to accepting kickbacks, using their positions to seek benefits for others, etc.
, involving drug admission and sales
.
With the gradual tightening of the country's compliance supervision of drugs and devices, the anti-corruption action in the medical field has also continued to expand
.
Since the beginning of this year, the National Health Commission, the National Health Insurance Administration, the State Food and Drug Administration and other relevant departments have continued to strengthen supervision, effectively deterring bribery, medical insurance fraud, sales with money and other violations of laws and regulations
.
.
Since the beginning of this year, the National Health Commission, the National Health Insurance Administration, the State Food and Drug Administration and other relevant departments have continued to strengthen supervision, effectively deterring bribery, medical insurance fraud, sales with money and other violations of laws and regulations
.
In the industry's view, the implementation of the Standards is conducive to giving full play to the role
of hospital evaluation standards in promoting hospitals to strengthen internal management and improve medical quality and safety.
It means that the inspection intensity has gradually become stricter, and the in-depth rectification of chaos in the pharmaceutical industry has officially begun, correcting the unhealthy trend
in the field of pharmaceutical purchase and sales and medical services.
of hospital evaluation standards in promoting hospitals to strengthen internal management and improve medical quality and safety.
It means that the inspection intensity has gradually become stricter, and the in-depth rectification of chaos in the pharmaceutical industry has officially begun, correcting the unhealthy trend
in the field of pharmaceutical purchase and sales and medical services.
Illegal procurement, malicious insurance fraud
The new version of the tertiary hospital review is closely monitored!
According to the interpretation of the "Tertiary Hospital Evaluation Standards (2022 Edition)" and its implementation rules by the National Health Commission, the revision of the "Standards" mainly has three aspects:
The first is to connect policy requirements and ensure policy consistency
.
According to the newly promulgated policy requirements of the state since 2020, relevant provisions
such as clinical application management of medical technology, nursing management, mutual recognition of examination and test results, hospital safety and order management, and facilitation of medical treatment for the elderly have been supplemented or updated.
.
According to the newly promulgated policy requirements of the state since 2020, relevant provisions
such as clinical application management of medical technology, nursing management, mutual recognition of examination and test results, hospital safety and order management, and facilitation of medical treatment for the elderly have been supplemented or updated.
The second is to absorb the progress of the industry and enrich the connotation
of standards.
In the past two years, the quality control indicators of professional or technical fields such as case management, cardiovascular system diseases, ultrasound diagnosis, rehabilitation hospitals, clinical nutrition, and digestive endoscopy issued by the Health Commission have been included, and the relevant provisions have been optimized
.
of standards.
In the past two years, the quality control indicators of professional or technical fields such as case management, cardiovascular system diseases, ultrasound diagnosis, rehabilitation hospitals, clinical nutrition, and digestive endoscopy issued by the Health Commission have been included, and the relevant provisions have been optimized
.
The third is to draw on practical experience and ensure the practicality of
standards.
According to the review practice of various places and the opinions of industry experts, some common terms and codes have been revised and improved, and the guarantee standards are in line
with the actual management of medical institutions.
standards.
According to the review practice of various places and the opinions of industry experts, some common terms and codes have been revised and improved, and the guarantee standards are in line
with the actual management of medical institutions.
The new version of the tertiary hospital review continues to pay close attention to illegal procurement and malicious insurance fraud
.
In the pre-requirement section, there are 3 sections and 25 pre-review clauses, including the occurrence of major price or charge violations, and malicious deception of medical insurance funds; and violating the Drug Administration Law of the People's Republic of China and the Regulations on the Supervision and Administration of Medical Devices by illegally purchasing or using drugs, equipment, instruments and consumables to carry out diagnosis and treatment activities, causing serious consequences; Unlicensed configuration for the use of large medical devices
that require admission approval.
.
In the pre-requirement section, there are 3 sections and 25 pre-review clauses, including the occurrence of major price or charge violations, and malicious deception of medical insurance funds; and violating the Drug Administration Law of the People's Republic of China and the Regulations on the Supervision and Administration of Medical Devices by illegally purchasing or using drugs, equipment, instruments and consumables to carry out diagnosis and treatment activities, causing serious consequences; Unlicensed configuration for the use of large medical devices
that require admission approval.
If one or more of the pre-requirements occur during the review cycle, the hospital shall postpone the review for one year, and the original level will be cancelled during the postponement period, and shall be managed
in accordance with "undecided".
It aims to further leverage the hospital review work in promoting the implementation of relevant laws, regulations, system requirements and reform policies in hospitals
.
in accordance with "undecided".
It aims to further leverage the hospital review work in promoting the implementation of relevant laws, regulations, system requirements and reform policies in hospitals
.
Hospital review is an important starting point for health administrative departments to perform their supervisory functions and promote the high-quality development of hospitals, and plays an important role
in promoting hospitals to improve their self-management level and achieve high-quality development of medical services.
in promoting hospitals to improve their self-management level and achieve high-quality development of medical services.
Industry insiders pointed out that with the continuous introduction of policies and the continuous improvement of regulatory methods, some practitioners in the medical field still take risks
in order to seek improper interests.
Since the beginning of this year, the relevant departments have intensified supervision, in addition to vigorously cracking down on illegal acts such as bribery, insurance fraud, and sales with gold in the pharmaceutical industry, the behavior of some personnel seeking benefits for others by virtue of their posts and positions has also become a "stubborn disease of medical corruption"
cracked down hard by regulatory departments in the new era.
in order to seek improper interests.
Since the beginning of this year, the relevant departments have intensified supervision, in addition to vigorously cracking down on illegal acts such as bribery, insurance fraud, and sales with gold in the pharmaceutical industry, the behavior of some personnel seeking benefits for others by virtue of their posts and positions has also become a "stubborn disease of medical corruption"
cracked down hard by regulatory departments in the new era.
Hospital inspections and strict plugging of loopholes
Regulatory upgrades, medical corruption nowhere to hide!
With the gradual tightening of the country's compliance supervision of drugs and devices, anti-corruption actions in the medical field have also continued to advance
.
.
Since the beginning of this year, the Central Commission for Discipline Inspection and the State Supervision Commission have repeatedly intensively reported on medical anti-corruption, drug kickbacks and other issues, and while medical representatives, pharmaceutical companies and other relevant personnel have been brought out, many "number one" in third-class hospitals have also fallen one after another
.
According to incomplete statistics released by the national and local discipline inspection and supervision departments, as of November, more than 50 hospital presidents and secretaries have been investigated, including more than 20 leaders from third-class hospitals
.
.
According to incomplete statistics released by the national and local discipline inspection and supervision departments, as of November, more than 50 hospital presidents and secretaries have been investigated, including more than 20 leaders from third-class hospitals
.
While strictly investigating the "number one", the drug regulatory system has also repeatedly intensively reported on medical anti-corruption, red envelope kickbacks and other issues, and the crackdown on commercial bribery in the field of pharmaceutical purchase and sales has continued to increase
.
On November 17, the State Administration for Market Regulation announced five typical cases of unfair competition in commercial bribery, highlighting two commercial bribery incidents in the medical and health industry, once again sounding the alarm about medical anti-corruption
.
.
On November 17, the State Administration for Market Regulation announced five typical cases of unfair competition in commercial bribery, highlighting two commercial bribery incidents in the medical and health industry, once again sounding the alarm about medical anti-corruption
.
On November 24, the National Health Insurance Administration issued the Interim Measures for the Administration of Flight Inspection of Medical Security Funds (Draft for Comments), which was once again open to the public for comments
.
Clarify the definition, principles, participation mechanism and other basic contents
of flight inspection.
At the same time, the "double random, one public" inspection mechanism and the form
of surprise inspection for situations such as reporting and complaints, intelligent monitoring, and media exposure are clarified.
Require that inspectors conduct investigations and collect evidence in strict accordance with the relevant provisions of administrative punishment procedures, that relevant individuals have the obligation to cooperate with the investigation, and that the subject of inspection has the right to
make statements and defenses.
.
Clarify the definition, principles, participation mechanism and other basic contents
of flight inspection.
At the same time, the "double random, one public" inspection mechanism and the form
of surprise inspection for situations such as reporting and complaints, intelligent monitoring, and media exposure are clarified.
Require that inspectors conduct investigations and collect evidence in strict accordance with the relevant provisions of administrative punishment procedures, that relevant individuals have the obligation to cooperate with the investigation, and that the subject of inspection has the right to
make statements and defenses.
At present, the national medical insurance flight inspection is still continuing
.
In July this year, the "2022 Medical Security Fund Flight Inspection Work Plan" was officially issued, which set the focus of this year's medical insurance flight inspection as 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).
.
In July this year, the "2022 Medical Security Fund Flight Inspection Work Plan" was officially issued, which set the focus of this year's medical insurance flight inspection as 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).
In fact, in the previous medical insurance flight inspection and illegal exposure cases, orthopedics, cardiology, hemodialysis, oncology and other fields, due to the large base of potential population, long and frequent diagnosis and treatment/rehabilitation cycles, or high medical insurance reimbursement ratio and amount, coupled with the complexity and uncertainty of medical behavior, violations of laws and regulations are extremely hidden, which can be said to be the "hardest hit area"
where problems are concentrated.
where problems are concentrated.
Industry experts pointed out that problems such as excessive diagnosis and treatment, decomposition and hospitalization, and split/duplicate charges in large public medical institutions have not been eliminated, empty beds, false treatment, and over/excessive medication in primary medical institutions are widespread, and the problems of internal and external collusion between designated medical institutions and suppliers, and unreasonable use of drugs and equipment joint insurance fraud are prominent; These problems will be hidden in the big data information of the new round of flight inspections
.
.
The relevant person in charge of the National Health Insurance Administration previously publicly stated that the medical insurance department will seriously investigate and deal with insurance fraud with a "zero tolerance" attitude, and in accordance with relevant laws and regulations, the designated medical institutions involved in the case will not only impose administrative fines, but also suspend until the termination of medical insurance service agreements; Where crimes or other related issues are involved, they shall also be transferred to the judicial, discipline inspection and supervision, health and other departments
.
.
