China News Service, Xining, April 29 (Reporter Sun Rui) The Qinghai Provincial Medical Insurance Bureau notified the first batch of cases of illegal use of medical insurance funds in Qinghai Province this year on the evening of the 28th.
According to the Qinghai Provincial Medical Insurance Bureau, since last year, medical insurance departments at all levels in Qinghai Province have always insisted on strengthening the supervision of medical insurance funds and maintaining the safety of medical insurance funds as their primary tasks, and continued to carry out special governance work on medical insurance violations. A number of cases of violations of laws and regulations of medical insurance funds have been investigated and dealt with in accordance with laws and regulations.
In order to play the role of warning and education, form an effective deterrent, and create a strong atmosphere for maintaining the safety of medical insurance funds and consciously resisting illegal and illegal acts, some cases are hereby notified as follows:
1. The case of illegal use of medical insurance funds by Ankang General Hospital, Chengdong District, Xining City
After investigation, the medical institution has behaviors such as retaining medical insurance cards, fictitious medical records, no purchase and sales accounts, and over-restricted drug use.
According to the medical insurance service agreement and related
It is stipulated that 78,095.2 yuan of illegal fees will be recovered, and 50,000 yuan of liquidated damages will be imposed; the medical insurance service agreement will be cancelled, and the qualification for medical insurance fixed-point service may not be re-applied for within 3 years, and the province will implement it jointly.
2. The case of illegal use of medical insurance funds by the community health service station of Ruiyuan Road, Chengzhong District, Xining City
After investigation, the medical institution has the behavior of swiping medical insurance cards for non-designated medical institutions.
According to the medical insurance service agreement and related regulations, the medical insurance department recovered 1,294 yuan of illegal fees; after canceling the medical insurance service agreement, it is not allowed to re-apply for the medical insurance fixed-point service qualification within 3 years, and the whole province will implement it jointly.
3. The Case of Illegal Use of Medical Insurance Funds by Xiehe Hospital of Ping An District
After investigation, the medical institution has the behavior of swiping medical insurance cards on behalf of non-designated medical institutions and settling drug expenses beyond the scope of medical insurance payment.
According to the medical insurance service agreement and related regulations, the medical insurance department recovered 5,443 yuan of illegal fees; the medical insurance service agreement was terminated, and the medical insurance designated service qualifications shall not be reapplied for within 3 years, and the whole province shall implement it jointly.
4. The case of illegal use of medical insurance funds by Guangming Road North Community Health Service Station in Golmud City
After investigation, the medical institution has the behavior of swiping medical insurance cards for non-designated medical institutions.
According to the medical insurance service agreement and relevant regulations, the medical insurance department recovered 79,507 yuan of illegal fees; the medical insurance service agreement was cancelled, and the medical insurance designated service qualifications shall not be reapplied for within 3 years, and the whole province shall implement it jointly.
V. The case of illegal use of medical insurance funds by the Garden Community Health Service Station in Golmud City
After investigation, it was found that the medical institution did not strengthen the verification of medical information of the insured persons, and settled the medical expenses of those with invalid cards or personal certificates; retained the patient's medical insurance card; the amount of card swiping did not match the amount of purchases; it is a designated medical institution for non-residents. Acts such as swiping urban and rural residents' medical insurance cards on behalf of others.
According to the medical insurance service agreement and related regulations, the medical insurance department recovered 21,807 yuan of illegal fees; the medical insurance service agreement was cancelled, and the medical insurance designated service qualifications shall not be re-applied for within 3 years, and the whole province shall implement it jointly.
6. The case of illegal use of medical insurance funds by Qinghai Leshengtang Pharmaceutical Chain Co., Ltd. Golmud No. 19 Chain Store
After investigation, the pharmacy has colluded with designated medical institutions to provide them with medical insurance cards for urban and rural residents, involving a large number of people, a large amount of money, and a bad social impact.
According to the medical insurance service agreement and relevant regulations, the medical insurance department shall cancel the medical insurance service agreement, and shall not re-apply for the qualification for medical insurance designated service within 3 years, and the whole province shall implement it jointly.
7. The case of illegal use of medical insurance funds by Fukang Chain Yanchuntang Pharmacy in Menyuan County
After investigation, the pharmacy has the behavior of swiping medical insurance cards for non-designated medical institutions.
According to the medical insurance service agreement and relevant regulations, the medical insurance department will recover 8,550 yuan of illegal fees; if the medical insurance service agreement is cancelled, it is not allowed to re-apply for the medical insurance fixed-point service qualification within 3 years, and the whole province will implement it jointly.
8. The case of illegal use of medical insurance funds by Changlutang Pharmacy in Menyuan County of Qinghai Jinzhu Pharmaceutical Chain Co., Ltd.
After investigation, the pharmacy colluded with the insured personnel to swipe the medical insurance card to exchange for cash.
According to the medical insurance service agreement and related regulations, the medical insurance department will recover 1,240 yuan of illegal fees; if the medical insurance service agreement is cancelled, it is not allowed to re-apply for the medical insurance fixed-point service qualification within 3 years, and the whole province will implement it jointly.
9. The case of illegal use of medical insurance funds by Lotus Pharmacy in Banma County, Guoluo Prefecture
After investigation, the pharmacy has behaviors such as swiping medical insurance cards for non-designated medical institutions and changing drugs.
According to the medical insurance service agreement and related regulations, the medical insurance department recovered 22,350 yuan of illegal fees; the medical insurance service agreement was cancelled, and the qualification for medical insurance designated service shall not be reapplied for within 3 years, and the whole province shall implement it jointly.
10. The case of illegal use of medical insurance funds by Renai Hospital in Yushu City
After investigation, the medical institution has repeated charges, alternate charges, over-standard charges, over-restricted payments by medical insurance, hospitalization with hanging beds, falsely prescribing drugs, and illegally increasing prices.
According to the "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds" and the relevant provisions of the service agreement, the medical insurance department recovered 1,860,243.93 yuan of illegal and illegal fees, and an administrative fine of 277,805.78 yuan; the medical insurance service agreement was cancelled, and the medical insurance designated service qualifications shall not be re-applied within 3 years. .
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