According to the latest news from the National Medical Insurance Bureau, 50 medical institutions in Taihe County, Anhui Province have problems using medical insurance funds in violation of regulations and laws to varying degrees, involving 57.951 million yuan in medical insurance funds.
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.
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 quickly investigate the situation, deal with it in accordance with laws and regulations, and send a working group to supervise and guide the situation.
At the same time, it is deployed nationwide to carry out centralized and special rectification work, strengthen the high pressure situation of fund supervision, and explore the establishment of a long-term mechanism for fund supervision.
On the basis of rigorous investigation and quick handling of the 4 hospitals involved, Anhui Province has investigated all 50 designated medical institutions in Taihe County one by one, since the establishment of the County Medical Insurance Bureau to the end of 2020 all 317,000 medical insurance cases.
With reference to the same method, Fuyang City fully covered 961,000 medical records from all designated medical institutions in other 7 counties and districts.
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service agreements of the 4 hospitals involved have been cancelled, the "Medical Institution Practicing License" has been revoked, the qualifications of 14 medical insurance physicians have been cancelled, and the illegal use of funds has been recovered.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.
Discipline inspection and supervision agencies have seriously held accountable the Fuyang City Government, Taihe County Party Committee, County Government and other 7 party organizations (units) and 19 responsible persons (1 department-level cadre, 7 county-level cadres, section-level and below) 11 cadres).
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.
The public security agency has filed 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.
It is reported that the National Medical Insurance Administration will report to the national medical insurance system the practice of investigating and handling fraudulent insurance cases in Taihe County in the near future, requiring medical insurance departments at all levels to carefully learn from Anhui’s experience, and have zero tolerance for medical insurance fraudulent activities. together. And 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 the fight against fraudulent insurance, and strictly prevent the medical insurance fund from becoming the new "Tang Monk". (Reporter Peng Yunjia)