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    Home > Medical News > Medical World News > Department of Social Affairs: Doctors who illegally prescription medical insurance can refuse to pay

    Department of Social Affairs: Doctors who illegally prescription medical insurance can refuse to pay

    • Last Update: 2021-02-04
    • Source: Internet
    • Author: User
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    On August 29, the Ministry of Manpower and Social Security issued the Opinions on Further Strengthening the Supervision of Basic Medical Insurance Medical Services, emphasizing the inclusion of the supervision of medical services in the fixed-point service agreement, while exploring the expansion of supervision to medical personnel, the establishment of a file of the integrity of medical personnel of fixed-point medical institutions, and the suspension of the real-time settlement of medical insurance eligibility or the cost of medical services provided by medical personnel will not be paid.
    Opinions clearly state that the fixed-point medical institutions service agreement should include the contents of medical services supervision, medical insurance agencies in accordance with the agreement to review the medical expenses paid to the fixed-point medical institutions, through the combination of supervision and assessment, assessment results and medical expenses settlement payment linked to the way, and constantly improve the agreement management. Focus on monitoring the number of insured persons attending hospitals, the total cost and growth rate of medical care, the total cost of medicines, medical supplies and examinations, the growth rate and the proportion of medical expenses and other indicators. For the first time, the opinion also explicitly explores extending oversight to medical personnel. Establish integrity files for medical personnel in designated medical institutions. Medical institutions can refine the requirements of the fixed-point service agreement to each medical staff head. Medical institutions should be encouraged to strengthen the incentive and restraint mechanism of medical personnel management by linking the results of medical personnel assessment with the assessment of fixed-point medical institutions and the payment and settlement of medical expenses. It is reported that the number of medical personnel, the number and growth of medical personnel, drug prescriptions and secondary average costs and total cost growth will be focused on analysis, while there are records of violations, the emergence of abnormally high average costs, the use of a drug abnormally high abnormal situation of medical personnel to carry out key checks.
    opinion points out that for acts suspected to be unreasonable diagnosis and treatment, hospitalization, drug use, charging, etc., the agency shall ascertain the actual situation and, if necessary, organize experts to demonstrate; For fixed-point institutions that violate the provisions of the agreement, the agency may, according to the seriousness of the circumstances of the breach, take measures such as refusing to pay fees, suspending the rectification of settlement deadlines, and terminating the agreement; The office may interview directly and order correction, and if the circumstances are serious, subjective and intentional, and the loss of the medical insurance fund is caused, the administrative institution may suspend its medical insurance real-time settlement qualification or refuse to pay for the medical services provided by it in accordance with the provisions of the agreement, that is, the medical personnel prescribed medical expenses shall be refused payment. (Health)
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