In China, the regulation of medical insurance funds is becoming more stringent than ever. No matter where you are, no matter what business you do, no matter how you act, you can't escape the web of regulation.
In the medical sector, one of the key players is retail pharmacies. For retail pharmacies, the health insurance fund is like a double-edged sword, which can be used for them or become an insurmountable curse. Therefore, in this complex environment, it is necessary to have strong supervision to ensure that pharmacies behave in accordance with regulations and prevent violations, so as to maintain the safety and sound operation of medical insurance funds.
At present, the medical insurance departments across the country have carried out unannounced inspections of designated retail pharmacies, which covers all levels of the country, focusing on the use of medical insurance funds. Designated retail pharmacies, which have become the targets of surveillance for the first time, have also become the focus of public attention.
"Purchase, sale and inventory" big data analysis, pharmacies can not be left to chance
The Guangzhou Municipal Medical Security Bureau recently announced that it will carry out on-site inspections of 500 designated retail pharmacies in the city.
This shows that the mainland not only continues the traditional on-site inspection method in the management of medical insurance funds, but also conducts all-round and efficient reviews of designated medical institutions with the help of modern information technology and big data processing capabilities.
According to the Guangzhou Municipal Medical Security Bureau, this inspection will deeply explore the "purchase, sale and inventory" and "prescription review" of pharmacies. These areas are a lifeline for pharmacies, and any small problem can turn into a big risk. Therefore, strengthening the supervision of these core businesses will effectively maintain the safety of medical insurance funds.
Investigate and deal with violations of pharmacies, and expose typical cases in many places
Recently, the Guangdong Provincial Medical Insurance Bureau exposed a number of typical cases of pharmacies using medical insurance funds in violation of laws and regulations. Among them, a pharmacy in Shenzhen was suspected of swiping a credit card for non-designated retail pharmacies to settle medical insurance. For this reason, the local medical insurance department refused to pay the party's medical insurance settlement fee of 662.00 yuan for the month in accordance with relevant regulations, and terminated the medical insurance agreement with the pharmacy.
In these cases, the main violations involved include the use of medical insurance cards to purchase drugs falsely, the exchange of drug consumables, and the forgery of vouchers. In response to these acts, the local medical insurance department has taken strict measures, such as terminating the medical insurance agreement, recovering the medical insurance fund, and transferring some serious cases to the public security organs for investigation and punishment.
This not only shows the zero-tolerance attitude of the mainland medical insurance fund management department to the chaos of pharmacies, but also reminds pharmacies and all medical service providers to abide by relevant laws and regulations and treat medical insurance funds in a legal and proper manner.
Medical insurance supervision continues to escalate, and pharmacies must standardize their operations
In recent years, the National Health Insurance Administration has issued a number of policies, including the inclusion of designated pharmacies in the overall reimbursement of medical insurance and the overall management of outpatient services, which has strengthened the connection between retail pharmacies and medical insurance.
In February this year, the National Health Insurance Administration issued the "Announcement on Strengthening the Inclusion of Designated Retail Pharmacies in the Coordinated Management of Outpatient Clinics" to increase the provision of drug services and include designated retail pharmacies that meet the conditions under the overall management of outpatient services.
Earlier, the National Health Insurance Administration also announced the "Guiding Opinions on Creating and Improving the "Dual Channel" Administrator System for National Medical Insurance Negotiation Drugs", which included designated retail pharmacies in the scope of negotiation drug supply guarantee, and jointly built a "dual channel" for negotiated drug reimbursement with designated medical institutions to improve the accessibility of drugs.
The implementation of these policies will further expand the scale of medical insurance funds for designated retail pharmacies. However, the medical insurance fraud involved in some designated pharmacies has been severely condemned, so the management of designated retail pharmacies will definitely be stricter. At the same time, this year's unannounced inspection of the National Medical Insurance Fund will also review designated retail pharmacies for the first time.
According to the work plan issued by the National Health Insurance Administration, one of the key points of supervision of designated retail pharmacies is to prevent drugs or other commodities that are improperly paid by the medical insurance fund, as well as to prevent empty and fraudulent use of medical insurance certificates.
Write at the end
In the next few years, we expect to see a more standardized, transparent and effective medical service system, so that countless people can enjoy high-quality medical services without worrying about the abuse or misappropriation of medical insurance funds. Medical insurance supervision will be further developed and constantly move towards a new stage, so as to ensure the safe, stable and effective operation of the medical insurance fund, and truly escort people's health.