On September 27th, the National Healthcare Security Administration held a press conference to establish a medical insurance payment qualification management system for personnel related to designated medical institutions. The reporter learned from the meeting that the scope of medical insurance supervision will extend from institutions to specific responsible persons. This system will start from the key link of medical insurance payment under the framework of medical insurance agreement management, and implement a "driver's license style scoring" for relevant personnel of designated medical institutions, thereby achieving dynamic and refined management. Designated medical institutions sign service agreements with medical insurance agencies, and relevant personnel involved in the use of medical insurance funds at this designated medical institution are eligible for medical insurance payment and are also included in the scope of medical insurance supervision Gu Rong, Director of the Fund Supervision Department of the National Medical Insurance Administration, introduced. The regulatory targets include two categories: the first category is hospital personnel, including medical, nursing, and technical professionals who provide services to insured persons, as well as personnel responsible for medical expenses and medical insurance settlement review. The second category is the main person in charge of designated retail pharmacies, namely the main person in charge on the drug business license. The reporter learned that the system implements dynamic scoring management. In the supervision work of the medical insurance department, if relevant personnel are found to have violated laws and regulations, they will be scored according to the severity of the problem. Relatively mild cases will receive 1-3 points, heavier cases will receive 4-6 points, more severe cases will receive 7-9 points, and the most serious cases of fraud and insurance fraud will receive 10-12 points. Those who score 9 points within a calendar year will have their medical insurance payment eligibility suspended for 1 to 6 months. Medical insurance expenses incurred during the suspension period for providing services will not be settled (except for first aid and rescue). If the score reaches 12 points within a calendar year, the eligibility for medical insurance payment will be terminated, and the medical insurance fees incurred for the services provided during the termination period will not be settled Gu Rong said that for those who have accumulated 12 points, they are not allowed to register and file again within one year from the date of termination; For those who accumulate 12 points at once, they are not allowed to register and file again within 3 years from the date of termination. At the same time, achieve nationwide networking linkage. Once the medical insurance payment eligibility is suspended or terminated in a designated medical institution, corresponding measures will also be taken in other designated medical institutions. If a region is scored and processed, the information will be shared nationwide, achieving cross institutional and cross regional linkage. In the long run, the medical insurance department will establish a "one person, one file" medical insurance integrity file for relevant personnel of designated medical institutions. Everyone will be given a unique ID code, which is unique for life in the national medical insurance system and does not change with the registered residence address and residential address. Everyone will also have their own medical insurance integrity file, which comprehensively records their scoring situation and other compliance with medical insurance related laws and regulations, accompanying their entire career. In order to handle the problem of whoever it is and prevent "accidental injury", Gu Rong introduced that the relevant guidance of this system is clear, and only those responsible for illegal and irregular behavior will be scored, while those who are not responsible will not be scored. According to the nature and severity of the behavior, those who are primarily responsible will receive more points, while those who are generally responsible will receive fewer points. At the same time, limit the scope to avoid dealing with a large surface area; Smooth the channels for objections and appeals, and improve the dispute resolution mechanism; Encourage correction and establish a repair mechanism. (New Society)