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    Home > Medical News > Medical World News > A community health station inside and outside collusion fraud insurance actually exceeded 30 million.

    A community health station inside and outside collusion fraud insurance actually exceeded 30 million.

    • Last Update: 2020-10-09
    • Source: Internet
    • Author: User
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    Recently, the Second Intermediate People's Court of Beijing reported 35 cases of fraud of medical insurance funds in the past year, of which medical institutions staff defrauded medical insurance funds, doctors involved in fraudulent insurance is particularly noteworthy.
    , according to the circular, individual doctors deliberately falsified hospital admission records, prescription records, and colluded with other hospital staff to share the reimbursement of the cost of the medical insurance fund.
    there are also individual doctors who, knowing that others are "drug dealers" who are posing for medical treatment, accept bribes from time to time to give them large quantities of medicine.
    report shows that from 2011 to 2017, legal representatives, pharmacy heads, accountants and nurses at a community health station in Beijing conspired to defraud the health insurance fund of more than 30 million yuan by using false drug storage registration, falsely entering the quantity of drugs, false registration and other means.
    according to the introduction, the relevant cases revealed that the medical insurance fixed-point medical institutions staff, to take fictitious medical services, forged medical charges documents, false insanity, the personal burden of medical expenses into the scope of payment of funds, named hospitalization and other acts to defraud the medical insurance funds.
    , it is not uncommon for people within medical institutions to be involved in fraudulent insurance.
    e.g. in 2019, the Beijing Medical Insurance Bureau reported that a Beijing orthopaedic hospital violated the law by charging more than one fee, the color super single system (90 yuan / system) in accordance with the multi-system charge (135 yuan / person), should not be charged separately to charge patients for supplies and other issues.
    In addition, a town health hospital in Beijing, a number of medical staff to take advantage of their position, in the night shift and non-working hours, the day-time medical treatment of self-funded patient prescriptions for refund, and then use the retained social security card re-registration, falsely create medical records, re-settlement, with the medical insurance fund to fill the gap in self-funded patient refund, and the withre of funds and related participants share, take the medical insurance fund 210,000 yuan.
    's top leaders made it clear that anti-corruption efforts in the financial sector should be "deepened" at the four plenary sessions of the Central Commission for Discipline Inspection held in early 2020 to investigate and punish collusion between medical institutions and outside the country.
    also said that we should resolutely investigate and punish medical institutions inside and outside the collusion fraud and insurance fraud, the establishment and strengthening of long-term supervision mechanism.
    In Shanyang County, Shaanxi Province, deputy director of the Health Bureau Xu Weicai, although the issue of fraud is an old problem, but the General Secretary in the plenary session of the Central Commission for Discipline Inspection clearly pointed out to "investigate and punish medical institutions inside and outside the collusion fraud fraud", this is the first time.
    Health Insurance Bureau led, supervision and upgrading recently, the State Health Insurance Administration issued the "2019 National Health Insurance Development Statistics Bulletin" shows that in 2019, health insurance departments at all levels to check a total of 815,000 designated medical institutions, the investigation and punishment of illegal and non-compliance with the drug institutions 264,000.
    , 6,730 medical insurance agreements were lifted, 6,638 administrative penalties were imposed and 357 were handed over to judicial organs; 331,000 people were dealt with in various places for illegal and illegal insurance, 6,595 were suspended and 1,183 were handed over to judicial organs; and a total of 11.556 billion yuan was recovered throughout the year.
    July 10, led by the Health Insurance Bureau, 12 departments in coordination with the General Office of the State Council on the promotion of health care fund regulatory system reform guidance for the supervision of health insurance fund put forward new requirements.
    this opinion a number of work requirements, all foreshadow the health insurance bureau will be in a new round of health insurance inspection in the dominant position, strong health insurance will have a big move.
    opinion requires that an intelligent monitoring system should be fully established.
    strengthen the guidance and audit of clinical diagnosis and treatment behavior in designated medical institutions, and strengthen the supervision in the past and in the event.
    in view of the characteristics of fraud and insurance fraud, we will constantly improve the basic information standard base and clinical guidelines such as medicines, medical treatment programs and medical service facilities, improve the intelligent monitoring rules, and enhance the intelligent monitoring function.
    to carry out real-time management of the purchase and sale of pharmaceuticals and medical supplies.
    should also increase the punishment of fraud and insurance fraud, drug comprehensive use of judicial, administrative, agreement and other means, severely punish the units and individuals who cheat insurance fraud.
    The medical security department shall, in accordance with the law, increase the intensity of administrative punishment, actively play the role of joint punishment of the department, and increase the deterrent effect of punishment on the designated medical institutions that have been confirmed by the medical security department and whose fraud and insurance circumstances are particularly serious, and the health and drug regulatory departments shall, in accordance with the law, suspend their business practices, revoke their qualifications for practice (operation) and restrictions on their employment.
    , the designated medical institutions and individuals with serious cases of fraud and insurance should be included in the list of joint disciplinary objects for loss of trust and joint disciplinary measures should be implemented.
    in the eyes of the industry, the Health Insurance Bureau is shouldering the burden, strictly controlling the unreasonable medical expenses of medical institutions, to ensure the safe and healthy operation of the health insurance fund, has become the main responsibility of the National Health Insurance Administration.
    medical institutions, including doctor's prescriptions, surgical supplies, etc., will be strictly monitored, China's medical reform has entered the era of medical insurance-led.
    .
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