Supervision whistle | strange medical records
The deceased actually went to the village health station to see a doctor, not only bought the medicine, paid the money, but also reported the bill on the medical insurance platform.
Such a thing happened before in Shibei Village, Danan Town, Muchuan County, Leshan City, Sichuan Province.
In July last year, when the staff of Muchuan County Commission for Discipline Inspection and Supervision carried out supervision and inspection at the county medical insurance center, a strange medical fee attracted the attention of Wang Junxiu, a member of the supervision team.
The system shows that Wu Mou, a villager in Shibei Village, died in November 2018, but from June to November 2019, there were five medical records of Wu Mou.
"There must be something wrong here!" Immediately, the County Commission for Discipline Inspection and Supervision conducted a preliminary check on the problem found.
It turned out that during the period of poverty alleviation, the civil affairs department uniformly purchased the following year's medical insurance for the five-guarantee households, low-income households and other groups at the end of each year.
After the rural insured seeks a doctor at the village health station, excluding the self-paid part, the annual outpatient fee of up to 160 yuan can be reimbursed, and the county medical insurance service center will settle the monthly settlement from the medical insurance fund to the outpatient institution.
After preliminary verification, the inspectors targeted Yang Jiugui, a village doctor in Shibei Village.
The inspection team came to the Shibei Village Health Station, asked Yang Jiugui about the situation, and retrieved the medical information of Wu on the medical insurance platform on the spot.
During the conversation, Yang Jiugui admitted the fact that medical insurance funds were obtained in the name of the deceased Wu.
"Dr. Yang, my father passed away. Do I need to cancel the medical insurance I bought at the end of last year?" According to Yang Jiugui, the idea of obtaining medical insurance funds by himself came from a policy answer.
Earlier, Wu's son asked him about the medical insurance policy. After answering the question, he suddenly thought, "If I use Wu's identity information to see a doctor, can I apply for reimbursement from the medical insurance center?"
With such an idea, Yang Jiugui did it with the information and authority he had in hand.
For the first time, he arbitrarily fabricated Wu's "medical treatment fee" of 19.9 yuan to test the water and successfully reimbursed it.
After that, he went to see a doctor in the name of Wu 4 times, reimbursed the outpatient expenses, and defrauded the medical insurance fund for overall payment.
By the end of 2019, the medical insurance purchased by Wu had expired, and it was impossible to repay in his name.
At this time, Yang Jiugui learned that Yuan Mou, a low-income household, had passed away, and he did the same, defrauding medical insurance funds in Yuan Mou's name.
In this way, Yang Jiugui fabricated medical information of deceased villagers 10 times to defraud medical insurance funds.
In the end, Yang Jiugui was warned and punished by the party, and the disciplinary money was recovered.
In response to the loopholes exposed in the case, the Muchuan County Commission for Discipline Inspection and Supervision issued a supervision proposal to the county medical insurance service center in a timely manner, ordering to improve the medical insurance reimbursement platform system and strengthen daily supervision and management.
At the same time, a special clean-up of the deceased's enjoyment of subsistence allowances, five guarantees, and social security funds was carried out in the county. 7 clues to the problem were found, and 5 people were punished by party discipline and government affairs, and the standardized reporting of death, serving time, missing persons (tracking) and other information was promoted simultaneously. system, effectively plug the loopholes in the system, and ensure the accurate distribution of funds for the benefit of the people.
(Correspondent Wang Mingxi Gou Xueling)