14 ministries: Strengthen the supervision of medical insurance funds and maintain a high-pressure situation in cracking down on fraud and insurance fraud

2024-05-29

According to the website of the National Health Commission, in order to effectively carry out the work of correcting unethical practices in the field of pharmaceutical purchasing and sales and medical services in 2024, the National Health Commission, Ministry of Education and other 14 ministries jointly formulated and issued the Notice on Printing and Distributing the Key Points for Correcting Unethical Practices in the Field of Pharmaceutical Purchasing and Sales and Medical Services in 2024. The Notice clearly states that we will strengthen the supervision of medical insurance funds, maintain a high-pressure situation in cracking down on fraud and insurance fraud, and carry out special rectification of illegal and irregular issues in medical insurance funds. The Notice consists of 5 parts and 15 articles, which are: firstly, to continuously regulate the order of pharmaceutical production and circulation. It includes four contents, namely: first, implementing the main responsibility and operating with integrity and compliance with the law. On the one hand, it emphasizes promoting the high-quality development of the pharmaceutical industry, implementing incentive policies, and improving the mechanism for forming pharmaceutical prices; On the other hand, we urge production and supply enterprises to fulfill their responsibilities as compliant business entities. The second is to accelerate volume based procurement and purify circulation order. Regularly carry out centralized and quantity based procurement of drugs and high-value medical consumables, and improve the procurement policies for medical equipment at all levels of medical institutions. The third is to focus on key links and increase disposal efforts. Pay close attention to risks in the pharmaceutical industry, such as project procurement, catalog preparation, price determination, project application, new drug application, and payment settlement, where power is concentrated, capital is intensive, and resources are abundant, and maintain a high-pressure governance situation. The fourth is to consolidate the effectiveness of rectification and improve long-term mechanisms. Mainly to strengthen the compliance guidelines for pharmaceutical production and operation enterprises, strengthen the management of social organizations, pharmaceutical representatives, etc., and standardize the order of drug circulation. The second is to concentrate on rectifying the unhealthy practices and corruption issues around the masses, which includes three aspects: first, to optimize internal management and standardize business service behavior. Strengthen the main responsibility of internal management in medical institutions, establish and improve an internal control system, and ensure the reasonable examination, medication, treatment, and standardized charging of patients during the medical treatment process. The second is to focus on the "two key points" and implement management requirements. Focusing on the "key minority" and key personnel in medical institutions, addressing management requirements, and addressing institutional measures in key areas such as recruitment, procurement, finance, and external cooperation. The third is to improve the policy system and innovate regulatory models. Optimize and improve the medical supervision and management system, enhance the precision supervision ability of information big data, and carry out pilot projects for intelligent and embedded supervision based on medical record information. The third is to resolutely rectify industry chaos, which includes two aspects: first, to strengthen supervision and law enforcement, and to crack down on illegal behavior. We will strengthen cross departmental joint law enforcement in medical supervision, and focus on violations in fields such as assisted reproduction, medical testing, physical examination, medical beauty, and Internet medicine. The second is to standardize live streaming sales and purify the online environment. Continuously strengthen the main responsibility of website platforms, and increase the supervision of medical online live streaming sales, information content, and dissemination order. The fourth is to effectively maintain the security of medical insurance funds, which includes two aspects: first, to strengthen the supervision of medical insurance funds and maintain a high-pressure situation in cracking down on fraud and insurance fraud. Implement and refine specific rules for the supervision and management of the use of medical insurance funds, improve the mechanism for daily supervision and inspection, conduct flight inspections, and carry out special rectification of illegal and irregular issues in medical insurance funds. The second is to improve price governance and continue to promote the reform of medical insurance payment methods. Steadily promote the governance of drug prices on the internet, implement a credit evaluation system for price bidding and procurement, and regularly implement dynamic adjustments to medical service prices. The fifth aspect is to deepen and consolidate the effectiveness of centralized rectification work, which includes four aspects, namely: first, classified disposal, and emphasis on joint punishment. We will handle the issue of hierarchical classification, adhere to the joint investigation of bribery and acceptance, and explore the establishment of a joint punishment mechanism for bribe givers. The second is to learn from cases and strengthen industry education. Solidly carry out industry education, increase integrity education for key personnel, and strengthen the promotion and explanation of industry regulations and medical insurance policies. The third is to carry out both rectification and construction, and strengthen the establishment of regulations and systems. Deepen the reform of institutional mechanisms, strengthen the construction of clean governance in the field of medicine and health, guide pharmaceutical enterprises, medical entities, and industry social organizations to improve their internal management regulations, and implement management responsibilities. The fourth is to closely cooperate and form a working synergy. Improve the level of information interconnection among various departments, ensure policy coordination, closely coordinate horizontally, strengthen vertical scheduling, and work together to promote the implementation of work. (Lai Xin She)

Edit:GuoGuo    Responsible editor:FangZhiYou

Source:chinanews.com

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