Strengthen the normalization supervision of medical insurance funds
2023-10-20
Recently, this year's medical insurance fund flight inspection work has been fully launched, and the flight inspection working group has been dispatched to local areas to implement regulatory and supervisory responsibilities. The medical insurance fund is the "medical money" and "life-saving money" of the people. It is necessary to further strengthen the supervision of the medical insurance fund and never slack off. The safe operation of medical insurance funds and the improvement of fund utilization efficiency are important foundations for reducing the burden of medical treatment on the public. Therefore, the relevant regulatory authorities have always made strengthening the supervision of medical insurance funds and maintaining fund safety the primary task of medical security, continuously carrying out special rectification, and cracking down on various illegal and illegal use of medical insurance funds. In recent years, through the combination of flight inspections, special rectification, and daily supervision, the high-pressure situation of medical insurance fund supervision has initially formed, and the regulatory power is constantly emerging, and the long-term mechanism is gradually improving. According to data from the National Medical Insurance Administration, from 2018 to 2022, 1.543 million illegal and irregular medical institutions were dealt with, and 77.13 billion yuan of medical insurance funds were recovered, exposing 245000 typical cases. Although the "blatant" fraudulent insurance practices have been curbed, old problems such as "running, emitting, dripping, and leaking" have not yet been effectively eradicated, and fraudulent insurance methods are becoming more covert. According to the 2022 medical insurance fund flight inspection situation announcement released by the National Medical Insurance Administration, among the 48 designated medical institutions sampled by the flight inspection team, there are problems with duplicate fees, exceeding standard fees, and decomposing project fees. Including medical expenses that do not fall within the payment scope of the medical insurance fund into the settlement of the medical insurance fund, there are still problems such as excessive diagnosis and treatment, excessive examination, and excessive prescription in violation of diagnostic and treatment standards. This indicates that the current regulatory situation of medical insurance funds is still severe and complex, and there is an urgent need to establish and improve a standardized regulatory system and methods, firmly guarding the safety bottom line of the fund. Since the beginning of this year, multiple relevant measures have been introduced, including the Interim Measures for the Management of Medical Security Fund Flight Inspection and the 2023 Special Rectification Plan for Combating Fraud and Deception in the Medical Insurance Field, to further strengthen the supervision of medical insurance funds and maintain the safety bottom line of medical insurance funds. In May of this year, the General Office of the State Council issued the Implementation Opinions on Strengthening the Normalization Supervision of the Use of Medical Insurance Funds, which pointed out that strengthening the normalization supervision of the use of medical insurance funds is of great significance for ensuring the safe operation of medical insurance funds, improving the efficiency of fund use, regulating medical service behavior, and reducing the burden of medical treatment on the public. These fully reflect the country's firm determination to crack down on illegal and irregular behaviors of medical insurance funds and maintain the safe and stable operation of medical insurance funds. Actively promoting an off-site supervision model characterized by remote supervision, mobile supervision, and early warning and prevention. By using intelligent supervision systems such as prior reminders, in process warnings, and post audit, the regulatory threshold for fund supervision has been moved forward... Currently, medical insurance fund regulatory departments at all levels are also further strengthening their supervision and law enforcement efforts, effectively implementing the regulatory responsibilities of all parties, strengthening the construction of fund supervision capabilities, and comprehensively utilizing various regulatory methods, Continuously improve the long-term regulatory mechanism, accelerate the construction of a standardized regulatory system for the use of medical insurance funds with clear rights and responsibilities, strict and powerful, safe and standardized, and efficient rule of law. At the same time, with a zero tolerance attitude, we will severely crack down on illegal activities such as fraud, hedging, and embezzlement of medical insurance funds, firmly uphold the safety bottom line of medical insurance funds, and achieve and maintain good
Edit：GuoGuo Responsible editor：FangZhiYou
Source：people.cn
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