China News Service, Xining, April 9th ​​(Sun Rui) Qinghai Provincial Medical Security Bureau held a press conference on the 9th to announce the handling of the first batch of fraudulent insurance violation cases in 2021.

　　According to Li Hanye, director of the Fund Supervision Division of the Qinghai Medical Security Bureau, since last year, based on public reports, daily inspections, and audits by the National Medical Security Bureau’s unannounced inspections and auditing departments, a number of designated medical institutions have been investigated and dealt with in accordance with laws and regulations regarding the illegal use of medical insurance funds. , Effectively cracked down on illegal activities in the medical insurance field, and worked hard to form a high-pressure situation in combating fraudulent insurance.

In order to give full play to 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 violations of laws and regulations, the following cases of violations of medical insurance laws and regulations are now publicly exposed.

1. Qinghai Xining Great Wall Hospital's medical insurance violations

　　According to the investigation, the hospital had behaviors such as bed hanging hospitalization and incomplete medical records. According to the relevant provisions of the Qinghai Province Medical Security Designated Medical Institution Service Agreement, the medical insurance service agreement was cancelled, and the medical insurance fixed-point service qualification cannot be re-applied within 3 years.

2. Violation of medical insurance in the large pharmacy of Xining Yuyitang

　　According to the investigation, the pharmacy has acted as a non-designated medical institution to swipe the card. According to the relevant provisions of the "Qinghai Province Medical Security Designated Retail Pharmacy Service Agreement", the illegal medical insurance fund was recovered for 6905.8 yuan, the medical insurance service agreement was cancelled, and no reapplication for medical insurance designated medical insurance was allowed within 3 years. Service qualifications.

3. Qinghai Province Fukang Pharmaceutical Chain Co., Ltd. Xinningtang Pharmacy Violation of Medical Insurance

　　According to the investigation, the pharmacy has acted on behalf of non-designated medical institutions to swipe the card. According to the relevant provisions of the "Qinghai Province Medical Security Designated Retail Pharmacy Service Agreement", the illegal medical insurance fund was recovered 9468.5 yuan, the medical insurance service agreement was cancelled, and no reapplication for medical insurance designated medical insurance was allowed within 3 years. Service qualifications.

4. Medical insurance violations of a community health service station on Ningda Road, Chengbei District, Xining City

　　According to the investigation, the medical institution has the behavior of swiping the card for non-designated medical institutions. According to the relevant provisions of the "Qinghai Province Medical Security Designated Medical Institution Service Agreement", the illegal medical insurance fund was recovered 724 yuan, the medical insurance service agreement was cancelled, and the medical insurance cannot be reapplied within 3 years. Qualification for designated service.

The picture shows the scene of the press conference.

Photo by Sun Rui

5. Medical insurance violations of Shangri-La Community Health Service Station in Chengzhong District, Xining City

　　According to the relevant provisions of the "Qinghai Province Medical Security Designated Medical Institution Service Agreement", the medical institution has been found to have swiped the card for a non-designated medical institution. The illegal medical insurance fund was recovered 800 yuan, the medical insurance service agreement was cancelled, and the medical insurance cannot be re-applied within 3 years. Qualification for designated service.

　　VI. Medical insurance violations of Chengdong Ruikang Integrated Traditional Chinese and Western Medicine Clinic in Xining City

　　After investigation, the medical institution has acted as a non-designated medical institution to swipe the card on behalf of the non-designated medical institution. According to the relevant provisions of the "Qinghai Province Medical Security Designated Medical Institution Service Agreement", the illegal medical insurance fund was recovered 1,400 yuan, the medical insurance service agreement was cancelled, and the medical insurance cannot be reapplied within 3 years Qualification for designated service.

　　7. Medical insurance violations of Huang Xuehui Internal Medicine Clinic in Chengzhong District, Xining City

　　After investigation, the medical institution had colluded with the designated medical institution to provide medical insurance settlement for the insured patients before obtaining the designated qualification, which seriously affected the normal order of medical insurance designated management. According to the "Qinghai Province Medical Institutions Medical Security Designated Inclusion and Exit Management Measures (Trial)" According to the relevant provisions of the Qinghai Province Medical Insurance Designated Medical Institution Service Agreement, the medical insurance service agreement is terminated, and the medical insurance designated service qualification cannot be re-applied within 3 years.

　　8. Medical insurance violations of Hongfei Pharmacy in Chengdong District, Xining City

　　After investigation, the pharmacy had the behavior of swapping and entering medicines. According to the relevant provisions of the "Qinghai Medical Security Designated Retail Pharmacy Service Agreement", the illegal medical insurance fund was refused 6,852 yuan, and the medical insurance service agreement was suspended for 3 months.

　　9. Violation of medical insurance in Jilan Pharmacy of Qinghai Fukang Pharmaceutical Chain Co., Ltd.

　　After investigation, the pharmacy had the behavior of swapping and entering medicines. According to the relevant provisions of the "Qinghai Medical Security Designated Retail Pharmacy Service Agreement", the illegal medical insurance fund was refused 10537 yuan and the medical insurance service agreement was suspended for 3 months.

　　10. Medical insurance violations of Quankang Medical Store in Chengxi District, Xining City

　　The investigation revealed that the pharmacy had entered drugs in exchange and failed to strictly abide by the price policy and regulations. According to the relevant provisions of the Qinghai Province Medical Security Designated Retail Pharmacy Service Agreement, the medical insurance service agreement was suspended for 6 months.

　　11. Violation of medical insurance in the first pharmacy of Qinghai Freed Pharmaceutical Co., Ltd.

　　After investigation, the pharmacy did not strictly abide by the price policy and regulations. According to the relevant provisions of the Qinghai Province Medical Security Designated Retail Pharmacy Service Agreement, the medical insurance service agreement was suspended for 3 months.

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