The National Medical Insurance Administration notified the special flight inspection of Wuhan Tongji Hospital

On April 20, the National Medical Insurance Administration issued an announcement to inform the special flight inspection of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology
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In March 2022, based on the reported clues, the National Medical Insurance Bureau, together with the National Health Commission and the State Administration for Market Regulation, conducted an unannounced inspection of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (referred to as "Tongji Hospital") to guide Hubei Provincial Medical Insurance Bureau, Wuhan The Municipal Medical Insurance Bureau will verify and deal with the relevant issues
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The person in charge of the Fund Supervision Department of the National Medical Insurance Administration informed that, after investigation, it was found that from January 2017 to September 2020, Tongji Hospital had the problem of collusion and false records of high-value orthopedic medical consumables, and fraudulently obtained medical insurance funds to pay 23343609.
64 yuan
.
Wuhan Municipal Medical Insurance Bureau made the following actions in accordance with the "Social Insurance Law of the People's Republic of China" and "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds": 1.
Order rectification; 2.
The hospital self-examined and voluntarily returned the amount of 19,157,462.
10 yuan defrauded for the medical insurance fund and imposed a fine of 2 times 38314924.
20 yuan; fined 5 times the fraudulent amount of 4186147.
54 yuan found in the inspection, 20930737.
70 yuan, totaling 59245661.
90 yuan; 3.
Order the hospital to suspend medical services involving the use of the medical security fund for 8 months; 4.
Report to the public security and the market in accordance with laws and regulations Supervision, drug administration, health, discipline inspection and supervision and other relevant departments transferred clues to the problem of the case
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At present, the loss of the medical insurance fund has been fully refunded, and the fines have been fully implemented
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The unannounced inspection also found that Tongji Hospital was suspected of illegally using 91.
0741 million yuan of medical insurance funds in other medical behaviors in 2021, which is still being further verified and processed
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In the next step, Hubei Provincial Medical Insurance Bureau and Wuhan Municipal Medical Insurance Bureau shall, according to the division of responsibilities, review and verify other problems found in unannounced inspections, and urge Tongji Hospital to make serious rectifications; at the same time, effectively protect the rights of the insured people to seek medical treatment, and suspend orthopaedic medical insurance services in Tongji Hospital During the period, the insured patients were guided in an orderly manner to go to the orthopaedic department of other hospitals for medical treatment
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The relevant person in charge said that the medical insurance fund is the "medical money" and "life-saving money" for the people.
Any illegal use of the medical insurance fund will damage the rights and interests of all insured persons.
The medical insurance department will take a "zero tolerance" attitude.
Seriously investigate
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For designated medical institutions involved in the case, according to relevant laws and regulations, not only administrative fines, but also medical insurance service agreements should be suspended or terminated; those involving crimes or other related issues should be transferred to judicial, disciplinary inspection and supervision, health and other departments
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All designated medical institutions should take the cases of violations of laws and regulations by Tongji Hospital as a warning, cultivate a strong sense of law-abiding, consciously standardize medical service behavior, provide reasonable and high-quality medical services for insured personnel, and effectively perform the main responsibility of standardizing the use of medical insurance funds
.