It's about seeing a doctor! A locality in Jiangxi reported 12 cases of violations

Source | Urban on-site comprehensive Shangrao medical insurance

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In order to guide the public to correctly recognize and actively participate in the supervision of the fund, further standardize the medical service behavior of designated medical institutions, and maintain the safety of the medical insurance fund, the 12 typical cases of illegal settlement of medical insurance in Shangrao City are hereby notified as follows:

1. Hengfeng County Sunshine Hospital illegal settlement of medical insurance funds. After investigation, it was found that Hengfeng County Sunshine Hospital repeatedly charged "general special nursing fees" and "pedigree puncture catheterization" and other violations, involving a total of 29300.8 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover the medical insurance fund that is settled in violation of the law, and give it another 2 times the penalty treatment; 2. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

2. Guangfeng Traditional Chinese and Western Medicine Hospital illegally settled the medical insurance fund case. After investigation, it was found that Guangfeng Traditional Chinese and Western Medicine Hospital had violations such as "low-standard admission", "unreasonable diagnosis and treatment", and "collusion projects", involving a total of 9992.92 yuan in medical insurance funds. The local medical insurance department handles: 1. Recover the medical insurance fund that is settled in violation of the law, and give it 3 times the penalty treatment; 2. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

3. Yugan County villager Song XX fraudulently used the identity of a low-income household to illegally settle the medical insurance fund case. After investigation, it was found that Song XX, a villager in Yugan County, borrowed the identity of li XX, a low-income household, for inpatient diagnosis and treatment and medical insurance reimbursement, involving a total of 57360.33 yuan in medical insurance funds. The local medical insurance department has transferred the case to the Yugan County Public Security Bureau for investigation, and at present, the medical insurance fund of 57360.33 yuan involved in illegal payment in this case has been recovered, and the public security organ will transfer it to the procuratorate for public prosecution and await the court judgment.

4. Yiyang Caoxi Town Health Center illegal settlement of medical insurance fund case. After investigation, it was found that there were violations such as "collusion projects" and "unreasonable diagnosis and treatment" in Caoxi Health Center in Yiyang County, involving a total of 4183.6 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover all medical insurance funds settled in violation of the law, and give 4 times the liquidated damages for the part of the "collusion project" involving 729.44 yuan of medical insurance funds; 2. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

V. Guangfeng Maternity and Children's Hospital illegally settled the medical insurance fund case. After investigation, it was found that Guangfeng Maternity and Children's Hospital had violations such as "low-standard admission" and "unreasonable diagnosis and treatment", involving a total of 11854.72 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover the medical insurance fund that has been settled in violation of the law and deal with 3 times the liquidated damages; 2. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

6. Wannian County Fukang Traditional Chinese and Western Medicine Hospital illegal settlement of medical insurance fund case. After investigation, it was found that Wannian County Fukang Traditional Chinese and Western Medicine Hospital had violations such as "high-set projects", "drug purchase and sales inconsistencies", "collusion projects", and "diagnosis and treatment beyond the scope of practice", involving a total of 58923.72 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Suspend the medical insurance service of the physiotherapy department of Fukang Traditional Chinese and Western Medicine Hospital for 3 months, and decide whether to resume it after the expiration of the period depending on the rectification situation; 2. Deduct 6 points each for doctors Hu XX and Yang XX, and suspend medical insurance services for 3 months; 3. Transfer the medical insurance problem suspected of exceeding the scope of practice to the Wannian County Health Commission for handling; 4. Recover the medical insurance fund that was settled in violation of the law and give 1 times the penalty treatment.

7. Shangrao and Kang Hospital illegally settled the medical insurance fund case. After investigation, it was found that Shangrao and Kang Hospital had violations such as "low-standard admission" and "irregular prescription management", involving a total of 7439.22 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Interview the hospital leader in charge and request rectification within a time limit; 2. Recover all medical insurance funds that have been settled in violation of the law and deal with 2 times the liquidated damages; 3. Deduct 3 points for the fixed doctor Luo XX points. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

VIII. Guangfeng Shangcheng Traditional Chinese Medicine Hospital illegally settled the medical insurance fund case. After investigation, it was found that There were violations such as "unqualified diagnosis and treatment" and included in medical insurance reimbursement, involving a total of 2280 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover the medical insurance fund that has been settled in violation of the law and deal with it with 2 times the liquidated damages; 2. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

9. Yiyang Hongyuan Hospital illegal settlement of medical insurance fund cases. After investigation, it was found that Yiyang Hongyuan Hospital had violations such as "low-standard admission", involving a total of 23530.08 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover all medical insurance funds settled in violation of the law and give 1.5 times the liquidated damages; 2. Deduct 3 points of the designated doctor's XX points and suspend the medical insurance service for 3 months; 3. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

10. Yiyang Dongsheng Hospital illegal settlement of medical insurance fund case. After investigation, it was found that Yiyang Dongsheng Hospital had violations such as "low-standard admission", involving a total of 28890.82 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover all medical insurance funds settled in violation of the law and give 1.5 times the liquidated damages; 2. Deduct 3 points of Zhang XX points for fixed doctors and suspend medical insurance services for 3 months; 3. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

11. Yiyang Renai Hospital illegal settlement of medical insurance fund case. After investigation, it was found that yiyang Renai Hospital had violations such as "low-standard admission", involving a total of 16115.72 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover all medical insurance funds settled in violation of the law and give 1.5 times the liquidated damages; 2. Deduct 3 points of wang XX points for fixed doctors and suspend medical insurance services for 3 months; 3. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.

12. Yiyang Yangyong Hospital illegal settlement of medical insurance fund case. After investigation, it was found that there were violations such as "low-standard admission" in Yiyang Yangyong Hospital, involving a total of 36777.12 yuan in medical insurance funds. The local medical insurance department handles the following: 1. Recover all medical insurance funds settled in violation of the law and give 1.5 times the liquidated damages; 2. Deduct 3 points of Ye XX points for fixed doctors and suspend medical insurance services for 3 months; 3. Require rectification within a time limit. At present, the medical insurance fund of the hospital's illegal settlement has been recovered and processed.