On April 20, the State Medical Insurance Bureau reported on the special flight inspection of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology. After investigation, it was found that between January 2017 and September 2020, Tongji Hospital had the problem of collusion and false recording of high-value medical consumables in orthopedics, and defrauded the medical insurance fund to pay 23343609.64 yuan. The Wuhan Municipal Medical Insurance Bureau will impose a fine of nearly 60 million yuan (59,245,661.92 yuan) on Tongji Hospital.
As a pillar department in the hospital, orthopedics has always been an income-generating department in the hospital due to the large number of consumables, high costs, fast patient turnover and high efficiency. Most of the consumables in orthopedics are high-value medical consumables, and in the orthopedics, and sub-specialties such as joints and spines as the pillar, the per capita cost of surgery is the highest, sixty or seventy thousand, or even hundreds of thousands is very common. After being billed by diagnostic-related groupings (DRGs), the most affected on medicare is orthopedics, especially joint replacement surgeries using high-value consumables.
So how do you cheat medical supplies out of medical insurance costs?
The orthopedic surgeon, who did not want to be named, told Health Times that the serial replacement of medical consumables refers to the non-catalog items such as medical consumables that are not paid by the medical security fund, and the string is replaced by the medical consumables in the medical security catalog for reimbursement or the low-standard charging items are put into the high-standard charging items for settlement. The simple understanding is that the billing is expensive a consumables, the actual use of cheap b consumables, shoddy; false memory refers to the recording of unused medical consumables, or over-reporting medical expenses.
According to the official website of Tongji Hospital, the Department of Orthopedics of Tongji Hospital was founded in 1946, which is a trinity of medical treatment, teaching and scientific research, and has a high medical and academic reputation at home and abroad. The Department of Orthopedics of Tongji Hospital is a national clinical key specialty and a quality control center of orthopedic medicine in Hubei Province.
After the wuhan municipal medical insurance bureau issued a notice, the official website of Tongji Hospital responded on the 19th, "Our hospital fully accepts, comprehensively and thoroughly rectifies, strengthens the accountability mechanism, seriously deals with the personnel involved, learns from each other, and resolutely prevents the recurrence of similar incidents." ”
It is reported that in addition to the fine of 59245661.90 yuan, the medical insurance bureau has suspended the medical services used by the orthopedic department of the hospital for 8 months involving the medical security fund. (Health Times, Zhao Mengmeng, Zhou Xinyu)
