In order to further strengthen the supervision of medical insurance funds and maintain the safety bottom line of medical insurance funds, the National Medical Insurance Bureau, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, and the National Health Commission recently issued the "2023 Special Rectification Work Plan for Combating Fraud and Deception in the Medical Insurance Field", and carried out special rectification work for combating fraud and deception in the medical insurance field nationwide. The plan is clear and will focus on cracking down on fraudulent insurance practices such as "fake patients" and "fake medical conditions". Specifically, we will focus on three areas: firstly, we will focus on key areas such as orthopedics, blood purification, cardiovascular medicine, examination, testing, and rehabilitation therapy. The second is to focus on key drugs and consumables. Monitor the use of key drugs and consumables funds that rank high in medical insurance settlement costs in 2022, including human serum albumin, atorvastatin, nifedipine, compound danshen tablets, Naoxintong pills, etc. Consumables include blood perfusion (adsorption) devices and sets, magnetic positioning therapy catheters, blood dialysis filters, etc., and pay special attention to other drugs and consumables that exhibit abnormal growth. The third is to focus on key behaviors such as false medical treatment and reselling of medical insurance drugs. Work requirements have also been specifically put forward for high-risk illegal and irregular behaviors after the implementation of policies for seeking medical treatment and outpatient coordination in different locations. In addition, the plan further clarifies and refines the responsibilities undertaken by the five departments of medical insurance, procuratorial organs, public security organs, finance, and health in the special rectification work. According to the plan, the National Medical Insurance Administration will focus on big data supervision in 2023, carry out pilot big data supervision, and screen suspicious clues through big data models such as "false hospitalization", "medical insurance drug reselling", "medical insurance electronic voucher cashout", and "key drug monitoring analysis", and distribute them to various regions for verification. (Outlook New Era Network)
Edit：qihang Responsible editor：xinglan
Source：People.cn
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