A fine of $680,000! A number of clinics, village health rooms, health hospitals involved in the case

Yesterday (February 18), the Chongqing Municipal Health Insurance Bureau announced the first batch of cases of illegal and illegal use of medical insurance funds in 2021, involving dozens of clinics, village health clinics and health hospitals.
unique, Yichun City, Jiangxi Province, recently also on the 2021 fight against fraud and insurance typical cases were notified.
, according to the Basic Physicians Commune, the fines imposed by primary medical institutions in both places amounted to nearly $680,000.
2021 "fraud insurance" the first shot has hit many clinics, village health rooms, health hospitals were fined 2021 "fraud insurance" the first shot has been fired, Chongqing City, Yichun City, these cases once again to sound the alarm.
Case I: Reimbursement of Drugs Falsely Opened using Patient's Health Insurance Card (1) Dr. He He, Yanwan Township Health Hospital, Feng festival county, Chongqing: From January 25, 2020 to October 29, 2020 During the period, 33 times to the township health hospital pharmacy to borrow medicine for their own, and then use the inpatient's medical insurance card falsely opened drugs to the pharmacy to bill and medical insurance reimbursement, defrauded the health insurance fund 2128.05 yuan.
The medical insurance department, in accordance with the relevant provisions of the Social Insurance Law of the People's Republic of China, recovered 2,128.05 yuan from a defrauded medical insurance fund and imposed an administrative fine of 10,640.25 yuan, which was notified in the county's "two-set" medical insurance institutions.
, the health department shall give Him a warning and punishment in accordance with the Law of the People's Republic of China on the Administration of Public Officials and the relevant provisions of the Regulations on personnel management of public institutions.
(2) Feng city Ya'an oral clinic: there are non-personal social security card swipe and other irregularities, involving the health insurance fund 800 yuan.
in accordance with the Social Insurance Law and the Medical Insurance Service Agreement and other relevant provisions, the medical insurance department shall recover 800 yuan from the medical insurance fund and deal with the breach of contract with a fine of 1600 yuan, interview its legal person and order rectification.
case II: serial exchange items, centralized credit card, account confusion (1) Qingyun Village Health Room in KowloonShan Township, Kaizhou District, Chongqing City: there are serial exchange projects, drug purchase and sale account management confusion and other violations of the breach of contract, involving the illegal use of the health insurance fund 103,000 yuan.
the relevant provisions, the medical insurance department recovered 103,000 yuan from the medical insurance fund and 414,000 yuan in default.
(2) Health Family Planning Service Room, Guangming Village, Hot Springs Town, Copper Drum County: There are violations such as serial drug exchange, centralized credit card, imperfect deposit accounts, etc., involving the medical insurance fund 4341.3 yuan.
the relevant provisions of the Social Insurance Law and the Agreement on Medical Insurance Services, the medical insurance department shall recover 4341.3 yuan from the medical insurance fund and shall be fined 8682.6 yuan.
(3) Gold Star Village Health and Family Planning Service Room, Hot Springs Town, Copper Drum County: There are violations such as serial drug exchange, centralized credit card, imperfect deposit accounts, involving the medical insurance fund 4726.1 yuan.
the relevant provisions of the Social Insurance Law and the Medical Insurance Service Agreement, the medical insurance department shall recover 4726.1 yuan from the medical insurance fund and shall be fined 9452.2 yuan.
(4) Health institutes under the pear tree in the town of Tanyu, Wanzhu County: there are irregularities such as retaining social security cards, serial exchange of drugs, inconsistent purchase and sale, uploading false medical insurance data, etc., involving the medical insurance fund 33531.6 yuan.
In accordance with the relevant provisions of the Social Insurance Law and the Agreement on Medical Insurance Services, the medical insurance department shall recover 33,531.6 yuan from the medical insurance fund, impose an administrative fine of 67,063.2 yuan, suspend medical insurance services for two months, and order rectification within a time limit.
(5) Wanzhu County Tanyu Joint Clinic: there are a series of drug exchanges, surprise swipe card and other irregularities, involving the health insurance fund 5055 yuan.
in accordance with the Social Security Law and the medical insurance service agreement and other relevant provisions, the medical insurance department to recover the medical insurance fund 5055 yuan, suspend medical insurance services for one month, and ordered a deadline for rectification.
case III: excessive medical treatment, inflated expenses (1) Chen Yu Clinic, Zhou Yixin Clinic, Kowloon Po District, Chongqing City: there are serial replacement projects, excessive medical care, inflated costs and other violations of the breach of contract, involving the illegal use of the medical insurance fund 198,000 yuan.
the relevant provisions, the medical insurance department recovered 198,000 yuan from the medical insurance fund and 788,000 yuan in default.
(2) Li Yifang Clinic, Yuanzhou, Yichun City: There are false settlement, fictitious medical expenses, irregular management of purchase and sale, etc., involving the medical insurance fund 39688.29 yuan.
In accordance with the relevant provisions of the Social Insurance Law and the Agreement on Medical Insurance Services, the medical insurance department shall recover 39,688.29 yuan from the medical insurance fund, impos an administrative fine of 79,376.58 yuan, suspend medical insurance services for one month, and order rectification within a time limit.
Case IV: Super-standard charges, super-restricted drug use (1) Fengcun Licun Health Hospital: there are super-standard charges, project correspondence errors, ultra-restrictive drug use and other irregularities, involving the medical insurance fund 20267.4 yuan.
relevant provisions, such as the Social Insurance Law and the Agreement on Medical Insurance Services, the medical insurance department shall recover 20,267.4 yuan from the health insurance fund and shall be fined 40,534.8 yuan.
(2) Feng city tugboat center health hospital: there are super-standard charges, serial exchange projects and other irregularities, involving the medical insurance fund 47368.8 yuan.
relevant provisions, such as the Social Insurance Law and the Agreement on Medical Insurance Services, the medical insurance department recovered 47,368.8 yuan from the health insurance fund and imposed an administrative fine of 94,737.6 yuan.
(3) Fengzhou Xiu City Health Hospital: there are super-standard charges, self-reliance project fees, ultra-restrictive drug use and other irregularities, involving the medical insurance fund 40579.7 yuan.
relevant provisions, such as the Social Insurance Law and the Medical Insurance Service Agreement, the medical insurance department recovered 40,579.7 yuan from the health insurance fund and imposed an administrative fine of 81,159.4 yuan.
(4) Baofeng Town Health Hospital, Jing'an County: there are excessive charges, project correspondence errors, ultra-restrictive drug use and other irregularities, involving the medical insurance fund 2311.62 yuan.
the relevant provisions of the Social Insurance Law and the Medical Insurance Service Agreement, the medical insurance department shall recover the medical insurance fund of 2,311.62 yuan and shall be fined 2,329.84 yuan.
(5) Gao'an City Village Health Hospital: there are low-cost projects high sets, ultra-restrictive drug use and other irregularities, involving the medical insurance fund 18,100 yuan.
, in accordance with the Social Insurance Law and the Medical Insurance Service Agreement and other relevant provisions, the medical insurance department recovered 18,100 yuan from the medical insurance fund and imposed an administrative fine of 36,200 yuan.
(6) Hualinshan Central Health Hospital, Gao'an City: there are super-standard charges, ultra-restrictive drug use and other irregularities, involving the medical insurance fund 6100 yuan.
the relevant provisions of the Social Insurance Law and the Medical Insurance Service Agreement, the medical insurance department shall recover 6100 yuan from the medical insurance fund and shall be fined 12,200 yuan administratively.
(7) Fangxi Central Health Hospital, Yifeng County: There are excessive diagnosis and treatment, ultra-restrictive drug use and other irregularities, involving the medical insurance fund 46830.81 yuan.
, according to the Social Security Law and the Health Insurance Service Agreement and other relevant provisions, the health insurance department to recover the health insurance fund 46830.81 yuan.
(8) Yifeng Xinchang Town Health Hospital: there are irregularities such as irregular diagnosis and treatment, ultra-restrictive drug use, involving the medical insurance fund 126737.96 yuan.
the relevant provisions of the Social Insurance Law and the Medical Insurance Service Agreement, the medical insurance department shall recover 126,737.96 yuan from the health insurance fund.
case five: low standard admission, hanging bed hospital (1) Gaoxian Luxi Central Health Hospital: there are super-standard charges, low standard admission and other irregularities, involving the medical insurance fund 50071 yuan.
the relevant provisions of the Social Insurance Law and the Medical Insurance Service Agreement, the medical insurance department shall recover 50071 yuan from the medical insurance fund and shall be fined 97,990 yuan.
(2) Shanghai GaoXianNo City Health Hospital: there are unreasonable charges, bed-mounted hospitalization and other irregularities, involving the medical insurance fund 22900.39 yuan.
relevant provisions, such as the Social Insurance Law and the Agreement on Medical Insurance Services, the medical insurance department shall recover the medical insurance fund of 22,900.39 yuan and shall be fined 15,534 yuan administratively.
The State Council and the Central Commission for Discipline Inspection have made it clear that 2021 will strictly investigate fraud and insurance just now, the State Council issued Order No. 735 - Regulations on the Supervision and Administration of the Use of Medical Security Funds, effective May 1, 2021, to provide more details on the future issue of fraud insurance in primary medical institutions, as detailed in the second tweet today.
Addition, in response to the problem of fraudulent insurance of medical insurance funds, the State Supervision Commission of the Central Commission for Discipline Inspection has also made it clear that 2021 is the beginning of the implementation of the 14th Five-Year Plan and the beginning of a new journey to build a socialist modern country in an all-round way.
health care work should adhere to the overall tone of steady progress, firmly grasp the theme of high-quality development of medical security, establish and improve the long-term mechanism of fund supervision, and constantly weave the cage of the medical insurance fund supervision system.
Primary physician commune for everyone to set the focus, daily to do these 12 items: (1) strictly abide by the real-name system of outpatient visits for insured personnel; Over-carrying drugs; (5) ensuring the authenticity and legality of diagnostic certificates, prescriptions, etc. and other documents; (6) conscientiously implementing the provisions of the basic medical insurance medical treatment service items and the basic drug catalogue; (7) complying with the financial accounting system of medical insurance to ensure the safety of the medical insurance fund; (8) taking stock of the drugs on a quarterly basis, establishing a deposit account for the purchase and sale of essential drugs, and reporting them to the township health hospitals in their jurisdictions.
(9) strictly follow the norms and technical routines of diagnosis and treatment, carefully write outpatient medical records, outpatient logs, the use of unified printing of special prescriptions, special bills.
medical documents, medical settlement records norms, clear truth and accuracy, preservation of integrity, is strictly prohibited to alter, forgery, concealment, destruction and so on.
(10) strictly follow the scope of access to basic medical care and technology, and may not practice beyond the permitted scope.
strict implementation of the Prescription Management Measures and the National Basic Drug Administration System, the use of non-catalog drugs to implement the notification system, to seek the consent of patients and signed by patients.
(11) Prescription drug names should use the Generic Name.
reasonable medication, scientific matching, diagnosis and prescription.
it is strictly prohibited to prescribe large prescriptions, hitchhiken drugs or prescriptions on behalf of others, each prescription shall not exceed 5 drugs, and the combined use of antibiotics shall not exceed 2 varieties.
(12) it is necessary to improve the quality of medical services, treat diseases, make reasonable diagnosis and use drugs reasonably.
, it is strictly prohibited to act in disorderly service such as procrastination, perfunctory service inaction, over their own medical conditions and service ability to forcibly intercept patients.