Draw inferences from one instance and plug the loopholes in medical insurance supervision
2021-10-20
Many villagers were suffering from "stroke"? Medical insurance reimbursement records after death? According to media reports, in cuikou village, Laihe Town, Shan county, Shandong Province, the medical insurance settlement records of multiple strokes have inexplicably appeared in the medical insurance accounts of urban and rural residents under the names of most villagers in recent five years. Related to the people's "life-saving money", the incident aroused widespread concern in the society. The details of the incident are incredible. A child just 5 years old has a medical insurance settlement record of stroke; There are still 48 medical insurance reimbursements after the death of an old man for a long time; Some villagers work outside all year round and have never been to the village clinic once, and the settlement records of stroke have also appeared in their medical insurance accounts; Some villagers' medical insurance accounts are still there, but the money is missing... According to the preliminary investigation of relevant departments in Shan county, there are problems in at least 37000 medical insurance settlement records of more than 2000 villagers in cuikou village. Moreover, not only cuikou village, similar situations also exist in other villages to varying degrees. Medical insurance records are fabricated out of thin air, and medical insurance accounts have been embezzled, involving such a wide range and an abnormal time of up to five years... Medical insurance funds are people's life-saving money, every penny should be used on the blade, and can not become the "Tang Monk meat" in the eyes of fraudsters. If there is a problem, find out the problem and respond to the query. Some villagers said, "almost every family has it, and our village should be renamed 'stroke village'." behind the ridicule and banter, there are lingering worries and doubts. They are worried that the medical insurance settlement record of stroke will affect normal enrollment and employment, military participation, insurance, insurance compensation, etc; They are concerned about where the trapped money flows behind the stolen medical insurance account. To dispel the people's doubts, we must thoroughly investigate and seriously deal with the exposed problems. At present, Shandong Medical Insurance Bureau has established a special steering group, and the National Medical Insurance Bureau will jointly carry out verification with Shandong provincial and municipal medical insurance bureaus. Why is such a large-scale abnormal medical insurance record? Whether it involves fraud and insurance fraud such as "false patient, false condition and false bill"? Who is responsible for this? Are there any problems of violation of rules and discipline, dereliction of duty and default of Party members, cadres and public officials? Not only the local villagers need to know the whole story, but also the public urgently needs a responsible answer. Regardless of the truth of the incident, it should be true that there are loopholes in the supervision of local medical insurance funds and the supervision responsibility has not been compacted. As we all know, medical insurance settlement needs to use my own medical insurance card. More than 2000 villagers can produce stroke medical insurance records without knowing, which makes people doubt the supervision of local medical insurance fund. In addition, more than 2000 villagers in a village have medical insurance settlement records of stroke, which is contrary to common sense. Why did the relevant regulatory authorities fail to find abnormal information through daily supervision, data monitoring, surprise inspection and other means, until the villagers were refused to buy commercial health insurance? The significance of a hot event is not limited to the case itself. The villagers suffering from "stroke" warned the regulatory authorities to draw inferences from one side and tie the institutional fence of medical insurance fund management tighter and closer. From the insurance fraud in Taihe, Anhui Province to the insurance fraud case led by the president of a private hospital in Sichuan recently announced by the Ministry of public security, insurance fraud has occurred from time to time in recent years, reflecting the severe situation of medical insurance fund supervision, warning us to strengthen supervision and explore effective ways of supervision. Discipline inspection and supervision organs should not only continue to rectify corruption and work style problems in the field of medical insurance, seriously investigate and deal with cases of fraud and insurance fraud involving party members, cadres and public officials, but also based on the re supervision of supervision, and promote relevant units to make up for system shortcomings and plug regulatory loopholes by strengthening supervision and inspection and making and issuing supervision suggestions. (outlook new era)
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