117 medical insurance doctors were punished for the use of medical insurance funds in violation of regulations.
Author ｜ Liu Chang
Source ｜ See the medical community (ID: vistamed)
The medical insurance fund illegally used, 117 medical insurance doctors were punished.
Recently, according to the Xiaoxiang Morning News, in accordance with the relevant notifications and work requirements forwarded by the Qinhuangdao Medical Security Bureau, the Medical Security Bureau of the Harbor District of Qinhuangdao City has verified that a batch of designated medical institutions in Harbor DistrictAnd medical insurance doctors have the act of using medical insurance funds in violation of regulations.
According to the relevant provisions such as the "Administrative Measures for the Institute of Medical Security Bureau of Hebei Province", the Medical Security Bureau of Haiang District, Qinhuangdao City made the following decisions: suspend the medical insurance service agreement of 3 hospitals and suspend 2 houses.Medical insurance services in the relevant department of the hospital; also suspended the medical insurance prescription of Chen Moua and Yu Mouchengs two medical insurance doctors, and gave 115 medical insurance doctors an annual assessment deduction.
The 117 medical doctor was punished, and the number could not be underestimated.In recent years, there have been many cases of punishment for medical insurance doctors for the use of medical insurance funds in violation of regulations.Once illegal and violations are illegally, they are lit. Medical insurance doctors points and suspend medical insurance service qualifications may face criminal liability. This situation is worthy of high attention to doctors.
In September 2024, in response to the use of medical insurance funds in illegal use of a clinic in Luzhou, the Luzhou Medical Security Bureau deducted 2 points for medical insurance doctors involved, and the credit score was 80.point.At the beginning of 2023, a group of typical cases of medical insurance violations exposed by the State Medical Insurance Bureau showed that many doctors were eligible for medical insurance services, ranging from 3-6 months.
Just in April this year, the Xiaoshan Medical Security Bureau revealed a group of typical cases of illegal illegal medical insurance doctors.Among them, the medical insurance physician Yang had repeatedly used the fake settlement infusion treatment and some drugs of the insured medical insurance card.In the end, Yang Moumou was scored 12 points in the medical insurance physician and lifted the "Medical Insurance Physician Service Agreement".
As early as May 2019, in a group of typical cases of fraud and fraudulent medical insurance funds notified by the State Medical Insurance Bureau, Sun Moumou, a doctor in a hospital in Kunshan City, Jiangsu Province, assisted others to pretend to be insuranceHuman -Social Security Card deceives a medical insurance fund of 25,400 yuan.Sun Moumou was eligible for medical insurance prescriptions and was transferred to the public security organs for further verification.
The medical insurance supervision is refined, and the doctor will take a good pen.The supervisory trend exchange meeting and the blue book conference were held in Beijing.At the meeting, as of September, the National Medical Insurance Administrations flight inspection had covered all provinces across the country. From January to September this year, the medical insurance departments at all levels across the country had recovered 16.06 billion yuan in medical insurance funds, an increase of 38.7%year-on-year.
Big data analysis of the State Medical Insurance Bureau shows that the inpatient rate of insured in some areas is significantly higher than other regions. Individual hospital hospitalization rates are high and extremely abnormal.According to the clues of big data, the National Medical Insurance Bureau conducted a flight inspection in many places. It was found that many medical institutions had the existence of pursuing the masses false hospitalization, no in -accordion hospitalization, no qualifications for medical treatment, forgery of medical documents, tampering inspection and inspection reports, fictional diagnosis and treatment projects, fictional diagnosis and treatment projectsWaiting for fraud and default.
Under the supervision of big data, the management of medical insurance has become more and more detailed. From the supervision of the medical institutions before, it is increasingly extended to the medical staff.Although some doctors said that the supervision of medical insurance "let the doctor have an additional mother -in -law", in fact, medical insurance supervision of doctors is more common internationally, and it is also the norm in China.
In March of this year, the Jining Medical Security Bureau took the lead in formulating and issuing the "Notice on Strengthening the Management of Related Personnel Related Personnel for Medical Insurance Insurance Payment of Points".Incorporate all personnel involved in the medical insurance fund into the scope of medical insurance supervision and management, punish individuals who implement violations of laws and regulations, and effectively enhance the consciousness and self -discipline of standardized diagnosis and treatment services."" ".
Half a year later, this notice became a national management specification.In September 2024, the State Medical Insurance Bureau issued the "Guiding Opinions of the State Drug Administration of the National Health and Health Commission of the National Health and Health Commission on the establishment of a designated pharmaceutical institution to the medical insurance payment qualification management system.The supervision of hospitals and pharmacies is mainly to refine supervision to medical staff.
That is to say, each doctors medical behavior will be directly presented on the medical insurance supervision big data platform, just like the "sky eyes" full of urban and rural places.Any "change", for example, a doctor has abnormal drugs and consumables, and the regulatory authorities will "see a panoramic view."Then, in terms of supervision, you can achieve "precise attacks", hundreds of times.
Some people in the industry said that medical service behavior is directly related to the vital interests of patients, and it is also the main part of the use of medical insurance funds.The potential potential.
"Medical Insurances management of medical service behavior will become thinner, stricter and stricter. In the" Sky Eye "of the big data of medical insurance supervisionDoing honestly is the only amulet that can avoid illegal. "The industry insiders said.(This article is published in "Seeing the Medical Community", reprinted must be authorized, and the author and source are indicated at the beginning of the article.)
