Dialysis medical insurance fund supervision three two things: use heavy blows to "targeted treatment" for fraud insurance

What are the methods of fraudulent insurance? Why not stop after repeated bans? How do individuals protect themselves? —— Dialysis medical insurance fund supervision "three two things"
Xinhua News Agency reporters Peng Yunjia, Gong Wen, and Shuicai
medical insurance fund are the "money bags" for the people to see a doctor, but some people regard the medical insurance fund as "Tang monk meat" and try to "drip and infiltrate" from it.
, Defrauding the medical insurance fund
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What are the means of defrauding insurance? How to protect the "life-saving money"? The State Council recently issued the "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds", which has given a "big punch" to the use and supervision of medical insurance funds
.
In the face of fraud and insurance, ordinary people have to keep their eyes open
.

Be vigilant! A wide variety of potentially fraudulent means
National Insurance Bureau in 2021 the first batch of the latest exposure of potentially fraudulent cases of fraud, including: Jinzhou City, Liaoning Province, Jin Jing hospital dean Huang Moumou together with people inside and outside the hospital by borrowing workers, residents, students apply for false Medicare card He was hospitalized and defrauded more than 2.
9 million yuan in medical insurance funds; Li XX, vice president of Chunwang Hospital in Wangchengpo, Changsha City, Hunan Province, and Liu XX, dean and legal person, defrauded more than 4.
25 million yuan in medical insurance funds for laboratory inspections.
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In recent years, medical insurance The continuous escalation of insurance fraud methods can be described as "various":-Excessive medical treatment and treatment of minor illnesses increase the cost
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Some hospitals push up medical expenses through unreasonable inspections, treatments, and medications, which not only increase the "burden" of patients but also increase medical insurance expenditures
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——Hanging bed for hospitalization, fraudulent treatment and defrauding of medical insurance funds
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Some medical institutions will admit patients who do not meet the admission requirements, hang out of bed to reimburse outpatient expenses, and even make up fictitious treatments
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——Swap medicines , split the charges, and set up names to deceive insurance in a disguised form
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Individual medical institutions have adopted higher-charged drug items, or retail pharmaciesSelling daily necessities by swapping medicines, and even directly using cash-out methods to cheat insurance
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——Excessive use of drugs, waste of funds and damage to health
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In order to defraud medical insurance funds, some hospitals use non-essential medications for patients and switch frequently during the trial period
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—— Induce medical treatment, doctors and patients collude to defraud insurance
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Some private medical institutions use medical examinations, rebates, cash rebates, etc.
to induce insured persons to be hospitalized, colluding with patients to defraud insurance
.

　　Why
fraud
protection "emerges in endlessly" "In recent years, medical insurance fraud has been high and frequent .
" Qin Yunbiao, political commissar of the Criminal Investigation Bureau of the Ministry of Public Security, said at a press conference a few days ago that in 2020 alone, public security agencies across the country have investigated and handled 1,396 such cases and captured them.
There were 1082 criminal suspects, and more than 400 million yuan of medical insurance funds were recovered
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Why does fraud and protection "emerge in endlessly"? In the final analysis, it is still profit-driven and "free to drill
.
" "Some insured persons always think that if they pay medical insurance premiums, they will suffer a loss if they don't use it
.
" Yang Yansui, a professor at the Institute of Hospital Management of Tsinghua University, said that if the insured has such awareness, it is easy to be "sacked" by a small number of medical institutions and practitioners.
Form a community of interests and cannibalize the medical insurance fund
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At present, the supervision of medical insurance funds mainly focuses on "after-the-fact supervision", and there is no closed-loop supervision chain for reimbursement subjects before and during the event
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Li Wenxing, secretary of the Disciplinary Committee of Zigong City, Sichuan Province, said that the supervision of medical insurance funds is a highly professional supervision, and some unreasonable or even illegal acts are difficult to identify and require professionals
.
"At present, an average of 1 staff member in Zigong City has to serve 17,645 insured persons
.
" Li Wenxing said, Zigong City has 158 employees in medical insurance administrative agencies and agencies at all levels, corresponding to more than 1,300 designated medical institutions, with 2,787,900 insured persons.
People, it is easy to have blind spots in supervision
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Li Yuanxin, director of the Institute of Health Policy and Medical Management of Shanghai Jiaotong University, said that the corresponding supervision system and mechanism need to be continuously improved, and the responsibilities of medical insurance agencies, designated medical institutions and other entities should be continuously strengthened
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　　"Targeted treatment" for fraudulent insurance with heavy punches
　　-Strengthening the legal system for the supervision of medical insurance funds
"The issuance of regulations will greatly enhance the supervision of medical insurance funds
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" The relevant person in charge of the National Medical Insurance Bureau stated that the "Implemented on May 1, 2021" The Regulations on the Supervision and Administration of the Use of the Medical Security Fund will provide a solid legal basis for promoting the safe and effective use of the fund
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　　——Intensive implementation of special treatment against fraudulent insurance The
National Medical Insurance Administration has carried out special treatment against fraudulent insurance for three consecutive years
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In 2020 alone, a total of 401,000 medical institutions in violation of laws and regulations were handled nationwide, and 22.
31 billion yuan of medical insurance funds were recovered
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The key to effective implementation of the supervision of medical insurance funds lies in showing an attitude of "relentlessness"
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In response to the problem of embezzlement, arbitrage, and fraudulent acquisition of medical insurance funds, the Commission for Discipline Inspection of Zigong City, Sichuan Province carried out listing and supervision, established a working mechanism for combating fraudulent insurance, and carried out combined ultrasound treatment, hemodialysis and other 4 projects to conduct network inspections, building a joint A solid firewall
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As of September 2020, Zigong City has recovered 43,886,100 yuan of medical insurance funds
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The key to effectively combating fraudulent insurance is also the "second half of the article" for supervision and management
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The Zigong Medical Insurance Bureau has improved the "blacklist" and personal punishment systems, and promoted reforms, treatment and construction by cases
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——Establishing and 　　improving the reporting and rewarding mechanism.
According to the relevant person in charge of the National Medical Insurance Bureau, in 2020, a total of 1,133 reporters will be rewarded nationwide, an increase of 88.
5% year-on-year, and a reward of 2,141,600 yuan will be issued, a year-on-year increase of 1.
47 times.

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The role of the masses' supervision has become increasingly obvious
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To raise awareness of self-protection, the public must also "say no" to fraudulent insurance
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In the face of fraudulent insurance, the public can call the National Medical Insurance Administration's reporting telephone number: 010-89061396 (7), or dial local reporting telephones, or report on the WeChat official account of the National Medical Insurance Administration, or submit written materials
.