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    Home > Medical News > Medical World News > A group of hospitals in Taiyuan were investigated and punished for medical insurance violations

    A group of hospitals in Taiyuan were investigated and punished for medical insurance violations

    • Last Update: 2019-12-19
    • Source: Internet
    • Author: User
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    By Wei Xiaoxiang Recently, according to the information of Taiyuan Medical Security Bureau, the city recently reported a number of cases of illegal collection of medical insurance fees by hospitals It is noteworthy that 12 medical institutions were reported, including 6 private medical institutions and 6 public medical institutions According to the report, the six reported private hospitals are Taiyuan zhengjitang Hospital of traditional Chinese medicine, Taiyuan Diabetes Hospital, Shanxi tianruikang rehabilitation hospital, Taiyuan hongjiyuan Hospital of traditional Chinese medicine, Taiyuan Great Wall orthopedic and hand surgery hospital, and Shanxi Wanfeng hospital The illegal amount varies from 4.11 million to 2000 yuan, totaling more than 4.8 million yuan The six public hospitals reported were Taiyuan Central Hospital (No.3 a), Loufan County People's Hospital, Gujiao Central Hospital, Qingxu County People's Hospital, Yangqu County People's Hospital and Taiyuan Taihang hospital The illegal amount ranged from 590000 yuan to 8000 yuan, totaling over 1.19 million yuan Not long ago, Hunan Medical Security Bureau issued a document to report the recent typical cases of fighting against fraud and illegal insurance In the six typical cases of serious fraud reported, a leading third-class hospital in the medical industry of Hunan Province is on the list Through investigation, the hospital has serious violations of medical insurance fund, such as falsely recording the cost of consumables such as surgical suture, over inspection and over medical treatment At present, all illegal medical insurance funds have been recovered and the total penalty is 33.5926 million yuan In fact, as early as August 2019, when Shandong Medical Security Bureau held a news briefing, it revealed a new trend According to Guo Jishui, deputy director of Shandong Medical Security Bureau, combined with the new trend, new trend and new characteristics of fraud and deception, Shandong decided to carry out a new round of special action against fraud and deception based on the early "storm action" In terms of the objects of investigation and treatment, it extends from primary medical institutions and private medical institutions to public secondary and tertiary medical institutions; in terms of the means of investigation and treatment, it extends from offline artificial audit to online intelligent monitoring, so as to promote the in-depth development of the supervision of medical insurance funds and effectively maintain the safety of medical insurance funds As for the extension of medical insurance investigation objects, it is not only the practice of Shandong Province From the latest developments in many parts of the country, it has gradually become the norm for medical insurance strict investigation objects to be transferred from primary medical institutions, private medical institutions to public secondary and tertiary medical institutions In recent years, from the supervision and supervision of the procuratorate to the construction of the Discipline Inspection Commission and the health and Health Commission, the inspection has become more and more strict Many doctors are also very tired of the current industry chaos, the income model, and want to get rid of it, and want to get sunshine income through proper ways, a director of a private hospital in Sichuan told the medical community But under the current medical system, it is not easy to lick blood on the edge of the knife, especially in the large-scale top three hospitals So if the medical insurance is tightened locally, it is very dangerous for medical workers So, what kind of warning has super Medical Insurance Bureau issued to medical institutions and doctors for its powerful means of public notification to super top three hospitals? Xu Yucai, deputy director of Shanyang County Health Bureau of Shaanxi Province, confessed to the medical community that there are three major warnings to remind hospitals and doctors to pay attention For a long time, there has been a misunderstanding in the issue of insurance fraud, especially in the public hospital managers and medical staff who always think that they have done well and have no problems However, if they don't check, they will be shocked There are many problems, focusing on the rationality of fees and diagnosis and treatment For a long time, our hospitals and doctors have been accustomed to treating many non-standard medical behaviors as normal They lack due knowledge that medical insurance fund is a life-saving fund for people's livelihood Even some hospital managers regard it as their achievements to be able to receive more patients and get more medical insurance subsidies They don't pay attention to the standardization of medical behaviors and don't work hard Now they are the iron fists In the era of medical insurance administration, hospitals should change their ideas In particular, it is illegal to obtain medical insurance fund in violation of regulations and may be punished by criminal law At present, the informatization of medical insurance is being actively promoted, and the management of medical insurance is changing from hospital management to doctor management Next, the four coding systems of disease, surgery, medicine and health materials are being established, and the coding of medical institutions, doctors, nurses, pharmaceutical personnel, medical insurance agencies and agents are being established In the future, the informatization management of medical insurance will take a new step In the future, the medical insurance supervision will change from the result of management to the process of management Anyone who violates the rules will directly restrict his / her behavior Furthermore, the health triangle (medical insurance, hospital, doctor) will become possible Doctors must be responsible for their own behavior That is to say, in the future, the payment of medical insurance for hospitals will become the payment of medical insurance for doctors Therefore, doctors must improve their level, improve their services and standardize their behavior before they can do so If we get more medical insurance funds, we will get more benefits Attachment: Notice on illegal behaviors of designated medical institutions issued by Taiyuan Medical Security Bureau 1、 Private medical institutions 1 Taiyuan zhengjitang Hospital of traditional Chinese medicine: there are excessive medical treatment, multiple declaration of one-time infusion set settlement fees, purchase of traditional Chinese medicine without tax tickets and declaration of medical insurance settlement fees with bills of the same trade, involving medical insurance fund of 685015.5 yuan According to the relevant provisions of Article 98 (17) (4) of Chapter VII liability for breach of contract and Article 47 of Chapter III Liability for breach of contract of "medical service agreement of designated hospitals of Taiyuan basic medical insurance in 2019-2020", deduct the principal of medical insurance fund of 685015.5 yuan, 5 times of liquidated damages of 3425077.5 yuan, totaling 4110093 yuan 2 Taiyuan Diabetes Hospital: there are behaviors of over standard charges, involving medical insurance fund of 91826 yuan According to the relevant provisions of Article 98 (12) and (16) of Chapter VII liability for breach of contract in "medical service agreement of designated hospitals of Taiyuan basic medical insurance in 2019-2020", the principal of medical insurance fund is deducted by 91826 yuan, and the liquidated damages of 5 times are 459130 yuan, totaling 550956 yuan 3 Shanxi tianruikang rehabilitation hospital: there are a series of laboratory charges, which are not charged according to the pricing unit, broken down charges, and are not in line with the admission point of collecting hospitalization and other behaviors, involving medical insurance fund of 23622.53 yuan According to the relevant provisions of Article 98 (15) of Chapter VII liability for breach of contract in "medical service agreement of designated hospitals of Taiyuan basic medical insurance in 2019-2020", deduct the principal of medical insurance fund of 23622.53 yuan, five times of liquidated damages of 118112.65 yuan, totaling 141735.18 yuan 4 Taiyuan hongjiyuan Hospital of traditional Chinese medicine: there are behaviors such as charging in violation of price regulations, repeated charging, no physical therapy single charging, over limit medication, etc., involving medical insurance fund of 7136.62 yuan According to the relevant provisions of Clause (7), (12) and (16) of Article 98 of Chapter VII liability for breach of contract in "agreement on medical service of designated hospitals of Taiyuan basic medical insurance in 2019-2020", the principal of medical insurance fund is deducted by 7136.62 yuan, and the penalty of 5 times is 35683.1 yuan, totaling 42819.72 yuan 5 Taiyuan Great Wall orthopedic and hand surgery hospital: there are behaviors such as over limit medication and multi charge, involving medical insurance fund of 3548 yuan According to the relevant provisions of Article 98 (7) and (17) of Chapter VII liability for breach of contract in "medical service agreement of designated hospitals of Taiyuan basic medical insurance in 2019-2020", deduct the principal of medical insurance fund of 3548 yuan, 5 times of the liquidated damages of 17740 yuan, totaling 21288 yuan 6 Shanxi Wanfeng hospital: there is a behavior of overcharge, involving medical insurance fund of 435 yuan According to the relevant provisions of Article 98 (17) of Chapter VII liability for breach of contract in "medical service agreement of designated hospitals of Taiyuan basic medical insurance in 2019-2020", deduct 435 yuan of principal of medical insurance fund, 2175 yuan of 5 times liquidated damages, totaling 2610 yuan 2、 Public medical institutions 1 Taiyuan City Center Hospital: there are decomposing charges, failing to strictly follow the consultation procedures to provide medical service charges, applying for external examination fees of non city designated institutions and other behaviors, involving 99842 yuan of medical insurance fund According to the relevant provisions of Article 98 (12) and (21) of Chapter VII liability for breach of contract in "medical service agreement of designated hospitals of Taiyuan basic medical insurance in 2019-2020", the principal of medical insurance fund is deducted by 99842 yuan, 5 times of the penalty is 499210 yuan, totaling 599052 yuan 2 People's Hospital of Loufan County: there are behaviors such as the charge is not consistent with the condition of the patient, over limit medication, no doctor's order, no charge for treatment sheet, etc., involving medical insurance fund of 54256.58 yuan According to the relevant provisions of Clause (7), (17) and (12) of Article 98 of Chapter VII liability for breach of contract in "agreement on medical service of designated hospitals of Taiyuan basic medical insurance in 2019-2020", the principal of medical insurance fund is deducted by 54256.58 yuan, 5 times of liquidated damages is 271282.9 yuan, totaling 325539.48 yuan 3 Gujiao Central Hospital: there are over treatment, no doctor's order, no physical therapy sheet, no report sheet charge, no charge according to the pricing unit, multiple charges, over limit medication and other behaviors, involving medical insurance fund 24176.88 yuan According to the relevant provisions of Article 98 (4), (7) (12) of Chapter VII liability for breach of contract in "medical service agreement of designated hospitals of basic medical insurance of Taiyuan in 2019-2020", the principal of medical insurance fund is deducted by 24176.88 yuan, 5-fold liquidated damages of 120884.40 yuan, totaling 145061.28 yuan 4 Qingxu County People's Hospital: there are behaviors such as over limit medication, repeated charges, no treatment sheet, consultation sheet charges, etc., involving medical insurance fund of 19410.53 yuan According to the relevant provisions of Article 98 (7) and (12) of Chapter VII liability for breach of contract in "medical service agreement of designated hospitals of Taiyuan basic medical insurance in 2019-2020", deduct the principal of medical insurance fund of 19410.53 yuan, 5 times of liquidated damages of 97052.65 yuan, totaling 116463.18 yuan.
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