Zhongxin Finance, May 19th. The website of the National Medical Security Administration released an announcement on the 2021 annual medical insurance fund unannounced inspection on the 19th. During the inspection, the national unannounced inspection team found that there were medical insurance management problems, repeated charges, and over-standard charges in the designated medical institutions. 5.03 Illegal and illegal use of medical insurance funds 5.03 billion.

　　According to the announcement, in 2021, the National Medical Security Administration, together with the National Health Commission and the State Administration of Traditional Chinese Medicine, will provide 68 designated medical institutions in 29 provinces across the country (29 third-level hospitals, 15 second-level hospitals, 22 first-level hospitals, 2 medical and elderly care institutions) to carry out unannounced inspections on the use of medical insurance funds.

Beijing, Inner Mongolia Autonomous Region and Xinjiang Production and Construction Corps have not completed on-site inspections due to the impact of the new crown pneumonia epidemic.

　　The announcement shows that the main problems found in the flight inspection are as follows:

　　(1) Issues concerning the management of medical insurance in designated medical institutions.

First, the hospital management is not standardized.

It is mainly manifested in the confusion of medical insurance card management, such as the storage of medical insurance cards of discharged patients in the inpatient department; the untimely update of medical insurance patient information in the inpatient department, etc.

　　Second, the implementation of system management is not in place.

The main manifestations are that medical institutions have insufficient understanding of the use of medical insurance funds in accordance with laws and regulations, or there are no specialized institutions and personnel responsible for the use and management of medical insurance funds, internal management systems are not perfect, not strict, normalized self-examination and self-correction are not in-depth, and medical insurance is used in violation of regulations. Funds happen from time to time.

　　Third, the management of medical records is not standardized.

The main manifestations are that the treatment files established by the hospital for the insured personnel are incomplete, there is no temporary doctor's order form, and some record forms do not have the doctor's signature.

　　(2) The use of medical insurance funds in violation of laws and regulations.

First, repeated charges, over-standard charges, and broken-down item charges.

59 of the 68 designated medical institutions inspected had such problems, and the amount of suspected violations of laws and regulations exceeded 150 million yuan, accounting for 30% of the total amount of suspected violations of laws and regulations.

　　The second is to exchange medicines, medical consumables, and diagnosis and treatment items.

Among the 68 designated medical institutions inspected, 50 had such problems, and the amount of suspected violations of laws and regulations was 96.46 million yuan, accounting for 19% of the total amount of suspected violations of laws and regulations.

　　The third is to over-diagnose, over-examine, over-prescribe, and over-prescribe drugs in violation of the diagnosis and treatment standards.

Among the 68 designated medical institutions inspected, 45 had such problems, and the amount of suspected violations of laws and regulations was 85.31 million yuan, accounting for 17% of the total amount of suspected violations of laws and regulations.

　　The fourth is to include medical expenses that are not covered by the medical insurance fund into the settlement of the medical insurance fund.

Among the 68 designated medical institutions inspected, 52 had such problems, and the amount of suspected violations of laws and regulations was 70.14 million yuan, accounting for 14% of the total amount of suspected violations of laws and regulations.

　　Fifth, decomposing hospitalization and hanging bed hospitalization.

Among the 68 designated medical institutions inspected, 14 had such problems, and the amount of suspected violations of laws and regulations was 2.7 million yuan, accounting for 0.5% of the total amount of suspected violations of laws and regulations.

　　Sixth, other violations of laws and regulations.

Among the 68 designated medical institutions inspected, 54 have problems such as exceeding the medical insurance payment limit for drugs, unqualified medical services, inconsistency between the purchase, sale and storage of drug consumables, false charges and other unreasonable charges. The suspected illegal amount is 97.94 million yuan. Accounted for 19.5% of the total amount of suspected violations.

(Finish)