On December 12, the Anhui Provincial Medical Security Bureau issued a notice on the illegal use of medical insurance funds by the Second People's Hospital of Wuhu City.
On July 2023, 7, the Anhui Provincial Medical Security Bureau received a petition report from Yang, reflecting that the Second People's Hospital of Wuhu City used the medical insurance fund in violation of laws and regulations by fictitious, collusive exchange of diagnosis and treatment services during his father's hospitalization due to cerebral hemorrhage. The Anhui Provincial Medical Security Bureau attaches great importance to it, and on the basis of data screening and analysis, on August 18, a provincial and municipal joint inspection team of more than 8 people formed with the Wuhu Municipal Medical Insurance Bureau was stationed in the hospital to conduct a comprehensive verification of the hospital charges and medical insurance reimbursement during the hospitalization of the whistleblower's father. Through medical record verification, on-site inquiry, data comparison, etc., it was verified that 8 of the 20 problems involved in the report were basically true.
After investigation, the hospital had problems such as excessive diagnosis and treatment, excessive examination, over-prescribing drugs, repeated charges, applied charges, and over-standard charges, involving a total of 21,82 yuan in illegal medical expenses, including 18,70 yuan in illegal use of medical insurance funds. In order to maintain the safety of the medical insurance fund and protect the legitimate rights and interests of patients, according to the medical insurance service agreement signed between the hospital and the Wuhu medical insurance department, the Wuhu Municipal Medical Insurance Bureau first handled the agreement according to the agreement:
The first is to recover the full amount of the medical insurance fund used in violation of regulations, and deduct 30,56074.41 yuan of liquidated damages according to the <>% cap;
the second is to interview the relevant person in charge of the hospital and order him to rectify immediately;
Third, they were handed over to the public security and health departments for further verification and handling. At present, all the above measures have been completed.
At the same time, the Wuhu Municipal Medical Insurance Bureau has initiated administrative punishment procedures in accordance with the Regulations on the Supervision and Administration of the Use of Medical Security Funds. While verifying the reported issues, the provincial and municipal joint inspection teams drew inferences from one case to another, and conducted a comprehensive extended inspection of the use of the medical insurance fund of the hospital from April 2022, 4 to May 1, 2023.
According to the report, on September 9, the Wuhu Municipal Medical Insurance Bureau gave written feedback to the whistleblower in the form of a regulatory notice in accordance with the "Implementation Rules for the Handling of Reporting Clues for the Supervision and Management of Anhui Provincial Medical Security Fund (Trial)". In accordance with the "Anhui Provincial Measures for Rewarding Reports of Illegal Use of Medical Security Funds", the whistleblower was given a reward of 25,5364.04 yuan for reporting.
The Anhui Provincial Medical Security Bureau said that all sectors of society are welcome to supervise the use of medical insurance funds in designated medical institutions, and will seriously deal with the problems verified and will not be tolerated. (CCTV News Client)