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Original title: Regain “Troubled” Health Insurance Fund of 22.3 Billion Yuan in 2020. National Health Insurance Administration: This Year’s Key Rectification of Unfounded Repeated Inspections
Every time the reporter Zhou Chengcheng Every time the editor Chen Xu
On February 20, the State Council Information Office held a periodic policy briefing by the State Council to present the “Regulations on the Supervision and Administration of the Use of Medical Security Funds” (hereinafter, the “Regulation”).
Shi Zihai, deputy director of the National Health Insurance Administration, stated in the briefing that in 2020, the National Health Insurance Administration, together with the health department, will inspect more than 600,000 designated medical institutions based on a comprehensive self-examination and self-correction. There are more than 400,000 medical institutions that violate laws and regulations, which means that more than half of designated medical institutions have problems with the use of funds to varying degrees. Last year, the health insurance fund recovered 22.31 billion yuan.
The health insurance fund is people’s “life-saving money” and it will usher in tighter oversight. Wang Zhenjiang, Director of the Third Legislative Office of the Ministry of Justice, stated that the Regulation, while further establishing and improving the oversight mechanism, comprehensively applies a variety of sanctions for different illegal entities, illegal acts and illegal situations, and establishes the corresponding legal responsibilities respectively, and increases the number of infractions Sanctions for behaviors cause offenders to pay a higher price, which in turn guides and urges users of the medical security fund to better comply with laws and regulations .
Personal insurance fraud is fined up to 5 times
On February 19, the “Regulation on the Supervision and Administration of the Use of Medical Security Funds” was promulgated, which will change the lack of laws and special regulations in the field of medical security in my country, and will provide legal guarantees for a more effective implementation of medical security. monitoring the use of the insurance fund and effectively maintaining the safety of the health insurance fund.
The “Regulation” clarifies the responsibilities of the relevant entities in the use of funds and comprehensively applies a variety of sanctions for different illegal entities, illegal acts and illegal situations, establishes the corresponding legal responsibilities and increases the punishment for illegal acts.
As for the medical security organizations, different illegal acts are distinguished. The “Regulation” provides for the order of correction, return, imposition of a fine and imposition of sanctions to the direct responsible and other direct responsible parties. For designated medical institutions, different illegal acts are distinguished, and sanctions are stipulated such as ordering corrections, interviewing relevant officials, ordering return, imposing fines, revoking practice qualifications, restricting employment, and sanctioning, respectively.
It is worth noting that the “Regulations” establish relatively severe penalties for fraudulent insurance.
Wang Zhenjiang introduced that in addition to sanctions such as ordering the return and revoking the qualifications of the practice, it also provides for fines of more than 2 times and less than 5 times the amount defrauded. According to the characteristics of the management of designated medical institutions agreements, provides for the suspension of medical services and the use of funds. Term and cancellation of the service contract, etc.
At the same time, in order to consolidate the management responsibilities of the person in charge of a designated medical institution, the legal representative or principal responsible will be restricted from practicing for 5 years if the designated medical institution causes significant losses to the fund. or serious adverse social impact due to violations of the law.
With regard to personal violations, Wang Zhenjiang stated that there are provisions to request corrections, request returns, and suspend online settlement of medical expenses for 3 to 12 months. For people who defraud insurance, such as designated medical institutions, a fine of more than 2 times and less than 5 times the fraudulent amount will be imposed.
Promote the effective use of health insurance funds.
While ensuring the safety of the health insurance fund, we must also promote the effective use of the fund.
In order to promote the use of health insurance funds by medical institutions in accordance with laws and regulations, Jiao Yahui, Inspector of the Office of Medical Administration and Hospital Administration of the National Health Commission, said that the Medical institutions must use medical insurance funds in compliance with laws and regulations, and to manage money that saves people’s lives, the National Health Commission has carried out tasks such as regulating the medical behavior of medical institutions and has carried out carried out a series of special actions.
For example, last year the “Opinions on Strengthening the Administration of Pharmaceutical Affairs in Medical Institutions to Promote the Rational Use of Medicines” and the “Guiding Opinions on Additional Regulation of Medical Conducts to Promote Reasonable Medical Inspections were issued. “. These two documents aim to save and rationally use health insurance funds and reduce unreasonable medical expenses by strengthening the management of rational use of drugs, focusing on strengthening the management of antitumor drugs, antibacterial drugs and auxiliary drugs and other drugs. key control.
Jiao Yahui stressed that this year a special rectification will be carried out in conjunction with the relevant departments to promote reasonable inspections. Focus on rectifying unfounded inspections and repeat inspections, and further promote mutual recognition of inspection results.
At the same time, the health department will also carry out the “Year of economic management” activities in public medical institutions to promote further standardization of financial management, price behavior and charges of medical institutions, promote the economic operation and management of public hospitals, and promote the rational use of health insurance funds.
In addition, you will further strengthen supervision and actively cooperate with the relevant departments in their work. Jiao Yahui introduced that through the reform of public hospitals, it is necessary to fundamentally solve the problem of rational use of health insurance funds in public hospitals, including the reform of payment methods, reform of the staff salary system physician and the establishment of a modern hospital management system.
It should be noted that on February 19, the XVIII meeting of the Central Committee for the Comprehensive Deepening of the Reforms reviewed and approved the “Opinions on the Promotion of Quality Development of Public Hospitals”.
Jiao Yahui said that during the “XIV Five-Year Plan” period, it is necessary to establish a modern hospital management system as a goal, promote the high-quality development of public hospitals, standardize the hospital’s refined management and information management, so that I continue to improve the level of management of public hospitals in my country and promote the reasonable use of medical insurance funds.
