National Medical Insurance Administration Announces 2022 Medical Insurance Fund Flight Inspection Status

2023-06-15

According to the National Medical Insurance Administration, the flight inspection status of the medical insurance fund for 2022 has been released recently. In 2022, a total of 48 designated medical institutions in 23 provinces were randomly inspected. After the national flight inspection team transferred the problems discovered during the inspection to the inspected area, the local medical insurance department of the inspected area dealt with the designated medical institutions with problems in accordance with the law and regulations. As of now, 720 million yuan of medical insurance funds have been recovered, 16 designated medical institutions have been fined 120 million yuan, and 7 designated medical institutions have been fined 25.251 million yuan for breach of contract. Some issues are still under further review and processing. Flight inspection is a form of tracking inspection, which refers to on-site inspections carried out without prior notice to the inspected department. It is an effective way to crack down on various types of fraud and insurance fraud. According to reports, the 48 designated medical institutions selected by the national flight inspection team include 40 tertiary public hospitals, 3 tertiary private hospitals, and 5 private medical institutions below the second level. The medical institutions that were randomly inspected mainly have duplicate fees, non-standard fees, and decomposed project fees; Swapping drugs, medical consumables, diagnosis and treatment projects, and service facilities; Include medical expenses that do not fall within the payment scope of the medical insurance fund into the settlement of the medical insurance fund; Excessive diagnosis and treatment, excessive examination, and excessive medication prescribed in violation of diagnostic and treatment standards. In addition, some medical institutions have other illegal and irregular issues such as decomposing hospitalization, inconsistent purchase, sales, and inventory of drugs and medical consumables, failure to strictly implement the national policy of centralized procurement of drug consumables, high dependency groups, and low standard admission under the DRG payment model; Some medical institutions have the problem of fictional medical service projects. Each medical institution at the verified point actively claims the issue, and through internal punishment of responsible personnel, comprehensive cleaning of non compliant and unreasonable diagnosis and treatment fee items, optimization of medical institution information system functions, establishment and improvement of a standardized management and assessment system for the use of medical insurance funds, multiple measures are taken to promote the subsequent rectification work of flight inspection. In 2022, 31 provinces conducted provincial-level flight inspections, inspecting a total of 2756 designated medical institutions, handling 2413 designated medical institutions that violated laws and regulations, recovering 1.98 billion yuan of medical insurance funds, imposing administrative fines of 160 million yuan, and imposing liquidated damages of 150 million yuan. Medical insurance departments in various regions shall impose corresponding penalties based on the severity of the problems found during the provincial flight inspection. The person in charge of the National Medical Insurance Administration stated that overall, the 2022 flight inspection will focus on large medical institutions in areas with abundant medical resources, pointing out typical problems in the use of medical insurance funds by these institutions, and urging designated medical institutions to carry out serious, comprehensive, and solid rectification, making phased progress in regulating the use of medical insurance funds. (Outlook New Era Network)

Edit:feiyi    Responsible editor:yifei

Source:gmw.cn

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