Today's Review
Let the medical insurance fund become an untouchable "high-tension wire"
Special commentator
There are many users of medical security funds, long chains, many risk points, difficult supervision, weak regulatory legal foundation, and some insured people, medical insurance designated hospitals and designated pharmacies are indifferent to the law, which has led to high incidence of fraudulent insurance.
The "Regulations on the Supervision and Administration of the Use of Medical Security Funds" are promulgated this time to complement legal shortcomings, strengthen technical means and reporting and reward systems, which are conducive to enhancing the sense of responsibility of medical institutions and individuals, and effectively forming the responsibility of maintaining the safety of medical insurance funds in the whole society. "Atmosphere.
The State Council Information Office held a regular briefing on the State Council’s policies on February 20, introducing relevant information on the Regulations on the Supervision and Administration of the Use of Medical Security Funds.
Qin Yunbiao, political commissar of the Criminal Investigation Bureau of the Ministry of Public Security, pointed out that in recent years, medical insurance fraud has occurred frequently. Some designated medical institutions cheated insurance on a large scale, and a group of criminals reselled drugs for profit.
The Ministry of Public Security has always attached great importance to combating medical insurance fraud crimes. In 2020 alone, public security agencies across the country have investigated 1,396 such cases, arrested 1,082 criminal suspects, and recovered more than 400 million yuan in medical insurance funds.
(For related reports, see version 03)
The medical security fund is the people's "medical care money" and "life-saving money". The safe use of the medical insurance fund involves the vital interests of the general public and is related to the healthy and sustainable development of the medical security system.
The "Regulations on the Supervision and Administration of the Use of Medical Security Funds" (referred to as the "Regulations") passed by the State Council Executive Meeting recently will come into effect on May 1 this year, providing an important legal weapon for ensuring the safety of medical insurance funds.
The "Regulations" require the establishment of a systematic medical insurance fund to use a supervision and management system mechanism, to build a supervision system that combines administrative supervision, news media supervision, social supervision, and industry self-discipline, and resolutely prevents medical insurance funds from becoming "tang monk meat" that is allowed to be defrauded.
The "Regulations" require greater penalties for illegal activities, comprehensive use of regulatory measures such as confiscation of illegal income, fines, revocation of licenses, restrictions on employment, suspension of medical services, and cancellation of service agreements to severely crack down on illegal activities in the use of medical security funds. Ensure that the medical insurance fund becomes a "high-tension wire" that no one can touch.
In recent years, medical insurance fraud crimes have occurred frequently and illegal acts have been shocking.
For example, at the end of 2020, multiple medical institutions in Taihe County, Anhui Province were exposed to fraudulent insurance.
In this typical case, the diagnosis is false, the patient is acting, and the ward is empty.
From the recent uncovered criminal cases of medical insurance fraud, it can be found that in some places there has been a gray interest chain in which intermediaries find people to be hospitalized, and fake patients receive money for hospitalization. Some medical institutions have also used replacement drugs, falsely prescribe physical therapy items, and false Surgery and other methods to obtain illegal benefits.
Criminals colluded internally and externally to defraud the medical insurance fund. All links in the gray interest chain have been caught up in oil and water, and the "life-saving money" of the broad masses has been seriously eroded.
In addition to the crime of medical insurance fraud, there are various "running and dripping" phenomena that are more common.
Some medical institutions have different degrees of over-diagnosis and treatment problems. Some medical institutions or individuals adopt methods such as imposing hospitalizations, false invoices, false examinations and treatments to obtain medical insurance funds.
There are also problems in some medical institutions that do not settle according to the proportion of medical insurance regulations, and include drugs and other items outside the scope of medical insurance payment into medical insurance settlement.
It is even more important to be vigilant that "running, dripping and leaking" violations in some places are spreading.
In 2019, the national medical security department inspected a total of 815,000 designated medical institutions, and 264,000 medical institutions handled violations of laws, regulations and contracts, accounting for 32% of the institutions inspected. The medical insurance fund recovered 11.56 billion yuan that year.
In 2020, the relevant departments inspected more than 600,000 designated medical institutions, plus the self-examination of designated medical institutions, dealt with more than 400,000 medical institutions that violated laws and regulations, and recovered 22.31 billion yuan in medical insurance funds.
The unhealthy trend of treating the medical insurance fund as a "Tang Monk Meat" that can be defrauded at will, and must be resolutely stopped.
There are many users of medical security funds, long chains, many risk points, and difficult supervision. Some insured people, medical insurance designated hospitals and designated pharmacies are indifferent to the law, and the legal basis for supervision is relatively weak. These are the continuing high incidence of fraudulent insurance Frequent reasons.
The "Regulations on the Supervision and Administration of the Use of Medical Security Funds" are promulgated this time to complement legal shortcomings, strengthen technical means, and strengthen the reporting and reward system, which is conducive to enhancing the sense of responsibility of medical institutions and individuals, and effectively forming a safe and secure medical insurance fund in the whole society Responsibility” atmosphere.
Fraud and insurance is an enemy of the people, and national laws must be incompatible.
The fraudulent insurance against the medical security fund ultimately damages the interests of every insured person and damages the image and credibility of the party and the government.
With the further consolidation and improvement of relevant laws and regulations, the medical insurance fund will surely bring “electricity” to the growing “teeth” and become a “high-voltage line” that must not be touched.