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Original title: I’m angry after reading it! The hospital transferred healthy elderly to the hospital and defrauded the National Health Insurance Fund. The director of a popular hospital was investigated
Recently, some media outlets exposed some designated medical institutions in Taihe County, Anhui Province, to induce false hospitalizations and hospitalizations. The problems were severe and the impact extremely severe.
According to Beijing News, some hospitals in Taihe County, Anhui Province, used the routine of “food and shelter, free physical examination” to attract the elderly who are not ill or slightly ill to be hospitalized, suspected of having health insurance. .background。
On December 20, according to CCTV News, as of December 19, Taihe County Public Security Organs had criminally detained 8 people. The president of the Fifth Taihe County People’s Hospital has been investigated and investigated by the Commission for Disciplinary Inspection and Supervision.DetentionThe main managers of the Puji Hospital for Traditional Chinese Medicine, Dongfang Hospital and Hemei Hospital areto acceptsurvey. The county health insurance office has suspended the settlement of health insurance for the 4 hospitals involved.
Take out the elderly without illness to obtain a medical insurance fund in the hospital
Recently, according to Beijing News, in Taihe County, Anhui Province, some hospitals used the “free hospitalization” routine to attract some healthy elderly to hospitalization and fabricate cases.borrowThis pool of health insurance funds.
To get people to the hospital, the hospital medical staff will reportedly take the initiative to “turn on the green light.”
At the Oriental Taihe Hospital, an old man who came to see a doctor did not feel bad, but he heard that he could stay in the hospital for free. The nurse at the medical guidance station was not surprised, “Able to live more than a week, maintenance of water, physical examination, food and shelter.Five GuaranteesFree, you only pay 200 yuan for a new ordinary rural cooperative medical system. “
Subsequently, the hospital doctor “compiled” a medical history of the elderly at the scene.Give you a stroke so you can have a CT scan of your brain for free. If someone asks you, they will tell you that you have a headache, stomach acid, and retching.. “During the treatment process, the hospital nurses even sent invitations.” Start in the village and see if you can start with three or five people. If they are willing to go to the hospital with you, they can give you two to three hundred yuan. “
During the hospitalization period, the hospital will not follow medical records for treatment, but there will be some “fictitious items” in the discharge checklist. This resulted in the hospitalization of a “false patient.” Health insurance may have to pay thousands of dollars, but hospital treatmentcostIt is very low.
In addition, the municipality has even developed an intermediary business that specializes in “picking up” hospitalized elderly people who are not sick.I was hospitalized 9 times a year in 3 hospitals for free, “I came to the hospital when I was bored at home, like playing.”
8 people have been arrested
On December 15, the National Health Security AdministrationMonitoring of fundsThe person in charge of the department stated that the National Medical Security Administration attaches great importance to the problem of insurance fraud in many hospitals in Taihe County, Anhui, and immediately instructs the Anhui Medical Security Bureau to quickly investigate the situation, treat it in accordance with laws and regulations and increase supervision throughout the province. Rigorously investigate and deal with illegal insurance fraudbehaviorTo maintain the security of the health insurance fund; send immediatelyjobsThe team went to Taihe County, Anhui Province, for on-site supervision. At the same time, a special nationwide rectification of fraudulent insurance fraud has been implemented to strengthen oversight and pressure on funds.
December 16, Anhui Disciplinary Inspection CommissionAnnounceAt the request of the chief officer of the Anhui Provincial Party Committee, the Anhui Provincial Disciplinary Inspection Commission has dispatched staff to Taihe County to guide and supervise the joint city-county investigation team to investigate suspected fraud insurance at many hospitals in Taihe County, according to media reports.
According to CCTV News on the 20th, recently, after some designated medical institutions in Taihe County, Anhui Province were exposed to induced hospitalizations and false hospitalizations, Fuyang City and Taihe County immediately established an investigation team. set to investigate and deal with them. The Provincial Health Insurance Office immediately formed a joint inspection and supervision team with the Provincial Health Commission to follow up and supervise Taihe County throughout the process to quickly and thoroughly discover the facts of the violations.
As of December 19,The Taihe County Public Safety Bureau has criminally detained 8 people，The Chairman of the Fifth Taihe County People’s Hospital has been examined and investigated by the Disciplinary Inspection Commission and has taken embargo measures. The directors of Puji Traditional Chinese Medicine Hospital, Dongfang Hospital and Hemei Hospital are under investigation. The county health insurance office has suspended the liquidation of health insurance for the 4 hospitals involved.
On December 18, the Anhui Provincial Health Insurance Office held a special government “retrospective” working video for designated medical institutions throughout the province.meeting, Implement the “look back” work of designated medical institutions convened jointly by the National Health Insurance Office and the National Health Commissionvideo conferenceSpiritually, the province’s special administration of designated medical institutions will “look back” and crack down on fraud and insurance.
The special management of designated medical institutions in Anhui province will focus on cracking down on fraudulent insurance problems such as induced hospitalization and bogus hospitalization, and requiresresponsibilityPeople are severely punished in accordance with laws and regulations. Special treatment includes the use of “include food and shelter, free physical examination, pickup and drop-off by car” or other methods such as “paid recommendation” to induce policyholders to do not comply with the hospitalization instructions to defraud health insurance funds; For patients who have not been hospitalized, they can manufacture diagnostic and treatment items and falsify medical treatment.InstrumentFraud health insurance funds by other means.
Individual medical institutions obtain medical insurance funds frequently
On December 19, Xinhua News Agency’s “Liaowang” News Weekly published a headline “How can I defraud health insurance and life-saving money to generate income?” “Article.
The article read: Driven by interest, illegal, illegal, and breach of contract, arbitration of health insurance funds is still prevalent in individually designated medical institutions, and the methods have become more professional and hidden, turning money from the Life-saving health insurance on a source of income.
Change the “face change”, change the name on your ownRefundAn outside regulatory agency checked the list of patient settlements at a hospital in central China and found that 398 yuanto importFor blood collection tubes, the hospital changes the corresponding names, that is, the self-funded items become reimbursable.
Often times, the more routinely and extensively items are used in clinical practice, the more likely they are to become the focus of the crossover. At a tertiary hospital in the south, the patient received an intravenous infusion (permanent needle) of about 10 yuan at a time, and the “venous catheterization” would become 60 yuan at a time. Based on this article alone, the hospital charged more than 5 million yuan in violation of regulations in more than a year.
Split loads, one trade counts as three times. In a university hospital, a cardio-cerebrovascular patient underwent coronary angiography, percutaneous transluminal coronary angioplasty, and percutaneous aortic balloon counterpulsation at the same time, performing 3 cases of digital subtraction angiography (intervention). According to local regulations, only one case is charged for the same operation, but in this hospital it was divided and collected three times. The original cost of 500 yuan was changed to 1,500 yuan.
By making unauthorized “digital” items, some designated institutions even have a scene where a day’s load of oxygen inhalation (continuous inhalation of oxygen) and ECG monitoring items exceeds the maximum number available in a single day.
Excessive medication, wastemoneyHarms health. In a tertiary hospital in southern China, the relevant departments found that the two special grade antibiotics that are used only for infections that are restricted to serious infections by health insurance and other antibiotics are ineffective not only used in non-essential patients rather, they are frequently changed during use. A team from the local health insurance office said the tricky place: frequent switching is avoiding an excessively high total amount of a certain drug and attracting the attention of regulatory authorities.
According to the News Weekly “Liaowang”, the National Health Insurance Bureau will deploy a special nationwide rectification of insurance fraudulent activities to strengthen fund oversight and high pressure. An insider in the health insurance industry suggested that more third parties andsocietyStrength and targeted introduction of the necessary supervision and inspectionFinanceaccounting, Medical drugs,information technologyProfessionals in legal affairs, etc., not only compensate for the shortcomings of the insufficient supervisory and inspection capabilities of the health insurance department, but also improve the professionalism, effectiveness and fairness of supervision and inspection.
(Source: Daily Economic News)
(Responsible editor: DF524)
I solemnly declare: The purpose of this information is to spread more information, and it has nothing to do with this booth.
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