China News Service, Beijing, June 6th. The reporter learned from the China National Medical Security Administration on the 6th that the bureau will shortly inform the national medical insurance system of Anhui Province’s investigation and handling of fraudulent insurance cases in Taihe County, and require medical insurance departments at all levels to defraud medical insurance. “Zero Tolerance” for the protection of behaviors, and resolutely investigate and deal with collusion between inside and outside medical institutions.
In December 2020, the media exposed four hospitals in Taihe County, Anhui Province suspected of fraudulent insurance.
The National Medical Insurance Bureau instructs the Anhui Provincial Medical Insurance Bureau to investigate and deal with it and send a working group to supervise it on site; carry out centralized and special rectification across the country, strengthen the high pressure situation of fund supervision, and explore the establishment of a long-term mechanism for fund supervision.
According to investigations, 50 medical institutions in Taihe County have problems using medical insurance funds in violation of regulations and laws to varying degrees, involving 57.951 million yuan of medical insurance funds (RMB, the same below).
Among them, 11 hospitals including the Fifth People's Hospital of Taihe County have serious insurance fraud problems, involving 13.873 million yuan in medical insurance funds.
Other counties and districts in Fuyang City also found suspected violations of 45.54 million yuan.
At present, the medical insurance service agreements of the 4 hospitals involved have been cancelled, the "Medical Institution Practicing License" has been revoked, the qualifications of 14 medical insurance physicians have been cancelled, and the illegal use of funds has been recovered.
There are 9 socially-run medical institutions in the city voluntarily applying for closure or suspension of medical insurance service agreements.
According to the National Medical Insurance Administration of China, the discipline inspection and supervision organs have held the Fuyang City Government, Taihe County Party Committee and County Government and other 7 party organizations (units) and 19 responsible persons accountable.
Among them, five responsible persons, including the deputy director of the county medical insurance bureau, were placed on file for serious violations of discipline and law and suspected of crimes and were investigated and taken lien measures.
In addition, the police have opened a case to investigate 9 hospitals in the county, verified 3470 people, adopted 56 compulsory measures, transferred 25 people for review and prosecution, and seized and frozen 3.609 million yuan of funds involved in the case.
During the investigation and handling of the case, Anhui Province successively carried out special governance "look back" in 2020 and special governance activities in 2021. As of the end of May, a total of 7,567 designated medical institutions were inspected, 56.608 million yuan of medical insurance funds were recovered, and 30.89 million yuan of liquidated damages were deducted. The administrative penalty was 4.315 million yuan.
In the near future, the National Medical Insurance Administration of China will inform the national medical insurance system of Anhui Province’s investigation and handling of fraud and insurance fraud cases in Taihe County, requiring medical insurance departments at all levels to carefully learn from Anhui’s experience, and have zero tolerance for medical insurance fraud and insurance fraud. , And cooperate with relevant departments to thoroughly investigate the work style and corruption behind it, and resolutely investigate and punish the collusion between internal and external medical institutions.
The bureau said that it will guide and urge all localities to make good use of the "Regulations on the Supervision and Administration of the Use of Medical Security Funds", further improve the long-term supervision mechanism, promote the full coverage and normalization of fraudulent insurance work, and strictly prevent the medical insurance fund from becoming a new "Tang Monk". (Finish)