Six out of 16 doctors were punished! Tai and four hospitals cheated the insurance notice came

The | chen and four hospitals fraudulently defrauded Medicare.
recently, the official website of the Medical Security Bureau of Fuyang City, "exposure desk" column published a notice, reported 5 cases of fraud and insurance fraud.
the media previously exposed tai he county three private hospitals, a public hospital suspected of taking health insurance funds, the results of the treatment was announced.
it is understood that the suspected fraud incident four hospitals, respectively, Taihe County Fifth People's Hospital (North District), Taihe Oriental Hospital, Taihe and Mei Hospital, Taihe Puji Central Hospital.
announcement showed that the total violation costs of 4 hospitals more than 3.8 million yuan, were recovered, 16 responsible physicians were deducted from the medical insurance physician points 12 points, cancel the medical insurance physician agreement, while lifting the hospital's medical insurance agreement settlement relationship.
Notified as follows: First, Taihe County Fifth People's Hospital (North District) suspected of defrauding medical insurance funds case investigated, Taihe County Fifth People's Hospital (North District) suspected of the existence of "packing, free medical examination, car pick-up, lower admission standards" and other inducements Hospitalization, false medical records, impostors, overtreatment, unreasonable drug use and other phenomena, rehabilitation medicine departments have reduced the patient's medical out-of-payment, subsidized meal expenses phenomenon, all patients admitted to the North District have subsidized meal expenses phenomenon, involving the amount of violations of 2.1273 million yuan.
Tai he county medical insurance department in accordance with the "Puyang City basic medical insurance fixed-point medical institutions service agreement" to recover the non-compliance costs of 2.1273 million yuan;
has now been handed over to the public security organs for processing.
II, Taihe Oriental Hospital suspected of defrauding the medical insurance fund case after investigation, Taihe Oriental Hospital suspected of falsifying medical records, reducing the standard of hospitalization, fee reduction induction, illegal drug use, over-treatment, serial exchange project charges, etc., involving the amount of violations of 1.0118 million yuan, Taihe County Medical Insurance Department according to the "Yuyang City Basic Medical Insurance" The fixed-point medical institution service agreement recovers the illegal fee of 1.0118 million yuan, and according to the Measures for the Administration of Physicians of the Medical Security Agreement of Fuyang City (Trial) and the Regulations on the Administration of Physicians of the Medical Security Agreement of Fuyang City (Trial), six responsible physicians are given 12 points to deduct the points of medical insurance physicians, cancel the medical insurance physician agreement, and terminate the settlement relationship of the medical insurance agreement of the hospital.
has now been handed over to the public security organs for processing.
Three, Tai he and the United States hospital suspected of defrauding the medical insurance fund case after investigation, Tai and the United States hospitals suspected of falsifying medical records, lower hospitalization standards, excessive treatment, serial project fees, fingerless inspection, super-standard charges, ill-documented and contradictory, the number of prescriptions does not match the list, excessive inspection, over-charges and other circumstances, involving the amount of violations of 6231 million yuan.
Tai and the county medical insurance department recovered the illegal expenses of 6231 million yuan in accordance with the Service Agreement of the Basic Medical Insurance Fixed-point Medical Institutions of Fuyang City, and gave 4 responsible physicians 12 points deduction points for medical insurance physicians, cancelled the medical insurance physician agreement, and dissolved the settlement relationship of the medical insurance agreement of the hospital in accordance with the Measures for the Administration of Physicians of the Medical Security Agreement of Fuyang City (Trial).
has now been handed over to the public security organs for processing.
I, Taihe Puji Zhong Hospital suspected of defrauding the medical insurance fund case after investigation, Taihe Puji Zhong Hospital is suspected of lowering the admission standard, inducing hospitalization, lowering the admission standard, overtreatment, irregular drug use, reduction of out-of-patient expenses and other phenomena, involving the amount of violations of 1345 million yuan.
county health insurance department in accordance with the "Puyang City basic medical insurance fixed-point medical institutions service agreement" to recover the illegal costs of 1345 million yuan.
According to the Measures for the Administration of Physicians in the Medical Security Agreement of Fuyang City (Trial) and the Regulations on the Administration of Physicians in the Medical Security Agreement of Fuyang City (Trial), two responsible physicians shall be given 12 points of credit for medical insurance physicians, and the medical insurance physician agreement shall be cancelled and the settlement relationship of the medical insurance agreement of the hospital shall be dissolved.
has now been handed over to the public security organs for processing.
The future medical insurance supervision will be regarded regarding public and private and after the incident, the Office of the State Health Insurance Administration, the General Office of the National Health and Health Commission jointly issued a "look back" notice on the implementation of the special governance of fixed-point medical institutions (Medical Insurance Office issued (2020) No. 58) "decided to immediately carry out a nationwide special governance of fixed-point medical institutions "look back", focusing on combating the problem of induced hospitalization, false hospitalization and other fraudulent insurance.
"Looking Back" has achieved remarkable results, according to the Yunnan Provincial Medical Security Bureau, since December 2020, the province's health insurance departments at all levels to carry out "look back" targeted medical institutions special governance actions, checked 3033 medical institutions, investigated 19 medical institutions existing irregularities, recovered all kinds of illegal funds 746.63 million yuan.
Xu Weicai, a columnist for "Looking at the Medical Community" and deputy director of the Health and Health Bureau of Shanyang County, Shaanxi Province, said that in the special governance "look back" notice, the evaluation of Tai and the incident was "bad in nature and very bad in impact".
nearly three years since the formation of the National Health Insurance Administration, the fight against fraud and insurance fraud has entered a new stage, however, under the iron fist, Tai he County actually exposed such a serious incident of fraud, it is really surprising.
this, it will also provide some warning about future regulation of health-care funds.
: health care penalties do not matter public and private tai and after the incident, the country quickly set off a governance "look back" activities.
recently issued a notice from the Qinghai Provincial Medical Security Bureau on the termination of the medical insurance service agreement for provincial workers of 17 pharmaceutical institutions, including the People's Hospital of Shelong County.
from the contents of the notice, the reason for terminating the medical insurance service agreement for provincial workers of 17 pharmaceutical institutions is that these institutions "failed to renew the agreement on time or failed to meet the conditions for resumption of service and reported overdue".
the Qinghai termination agreement does not appear to have any relationship with Medicare reimbursement, it also shows the importance of the agreement.
and from the Tai he incident and medical insurance flight inspection due to medical behavior irregularities and other penalties and circumstances, medical insurance inspection will be fully covered, the punishment is not divided between public and private, who violates the law on the punishment of who.
don't think you're the boss of a public hospital, health insurance will be on the net.
Surgency II: Health insurance supervision will move towards the rule of law normalization, and will certainly become more and more stringent reasons for making such a judgment, based on the following two reasons: First, the "Health Care Fund Use Supervision and Administration Regulations (Draft)" has been adopted at the Executive Meeting of the State Council on December 9, which means that the future supervision of health insurance funds will be legal in accordance with the law.
2nd is in the medical insurance (2020) No. 9 letter clearly put forward that the medical insurance fixed-point medical institutions to regulate the use of medical insurance funds behavior of the special governance work to implement "classification treatment."
The classification processing here means: for self-examination and rectification period before the end of the initiative to return in full illegal and illegal income, all rectification in place of fixed-point medical institutions, can be light, reduced or exempted from punishment.
After the end of the period of self-examination and rectification, in the spot check or flight inspection, found that the fixed-point medical institutions self-examination and rectification is weak, not returned in full and on time illegal income, or there are still illegal and illegal use of medical insurance funds, we must adhere to zero tolerance, according to the law from heavy punishment, and public exposure.
Of course, can we completely solve the problem of fraud and insurance, perhaps there is still a long way to go, but also need to cure the disease, and here "this" mainly has two points, one is to stop allowing medical institutions to expand indiscriminately, in accordance with the Romer Law to provide induced demand;