Contracting hospital departments and carrying out external diagnosis and treatment in the name of the hospital, a company was fined 50,000 yuan.
Author: Zhao Xiaohua
来源|看医界(ID:vistamed)
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An institution was fined 50,000 yuan
On April 8, the Shenzhen Municipal Health Commission issued an announcement on the delivery of the "Administrative Penalty Decision". According to the announcement, a company in Shenzhen was fined 50,000 yuan for contracting the five departments of traditional Chinese medicine of a private hospital and carrying out diagnosis and treatment activities in the name of the hospital.
According to the announcement of the delivery of the "Prior Notice of Administrative Punishment" issued by the Shenzhen Municipal Health Commission on February 7, it was ascertained in accordance with the law that the company signed the "Agreement on the Filing of the Cooperation between the Scientific Innovation Construction Management of Traditional Chinese Medicine and the Project of the Third Class A Hospital" with the above-mentioned private hospital, and was suspected of contracting the five departments of traditional Chinese medicine of the hospital and carrying out diagnosis and treatment service activities in the name of the hospital. It is proposed to impose an administrative penalty of a fine of 50,000 yuan.
According to the opinion of the administrative organ of the Shenzhen health department, the above-mentioned illegal acts violated the first paragraph of Article 27 of the Shenzhen Special Economic Zone Medical Regulations, that is, medical institutions carrying out practice activities shall apply to the health department for practice registration and obtain a medical institution practice license.
For those who violate this provision, the "Regulations" make it clear that the health department shall order the illegal acts to be stopped immediately, confiscate the illegal gains, drugs and medical devices, and impose a fine of not less than 50,000 yuan but not more than 200,000 yuan if there are no illegal gains, the illegal gains cannot be determined, or the illegal gains are less than 10,000 yuan, and a fine of not less than 5 times but not more than 20 times the illegal gains shall be imposed if the illegal gains are more than 10,000 yuan.
In the end, in accordance with Article 131 of the Regulations on Medical Care in the Shenzhen Special Economic Zone and with reference to the <深圳经济特区医疗条例>provisions of No. 10 of the Discretionary Standards for Administrative Penalties, the local authorities decided to impose an administrative penalty of a fine of 50,000 yuan on the company.
Leasing or contracting departments, medical institutions will also be punished
Although mainland laws and regulations clearly prohibit medical institutions from leasing or contracting departments in violation of regulations, there are still medical institutions that take risks, and many medical institutions have been fined in recent years, which also sounds a wake-up call for the operation and operation of medical institutions.
In August 2023, an administrative penalty decision published by the Zhejiang Provincial Government Service Network showed that a hospital (general partnership) in Wenzhou was confiscated of 220,000 yuan of illegal income and fined 1.672 million yuan for leasing and contracting medical departments.
In September 2022, according to the clues of the public's complaints and reports, the Health Bureau of Haishu District, Ningbo City, investigated and dealt with the behavior of leasing and contracting medical departments of a traditional Chinese medicine outpatient department in accordance with the law. According to the relevant provisions, the party was fined 20,000 yuan as an administrative penalty.
Among the top ten typical cases of health administrative law enforcement in 2021 previously notified by the Zhejiang Provincial Health Commission, two more cases were identified as "department contracting" under the banner of "department cooperation". One of them is a geriatric hospital, and after investigation, it was verified that the hospital had entered into an agreement with Zhao, and Zhao was responsible for hiring personnel, configuring equipment, and carrying out lithotripsy diagnosis and treatment activities in the name of the hospital.
In the end, the local health commission gave Zhao an administrative penalty of confiscation of about 567,000 yuan of illegal gains and a fine of 8,500 yuan in accordance with the law. The hospital will be dealt with in a separate case.
The other involved an aesthetic clinic. According to the disclosure, the clinic leased the cosmetic surgery and medical laboratory departments to a health management company, during which a total of 102 medical cosmetic surgeries were carried out, and illegal gains of 109,000 yuan were obtained, and finally the relevant departments were warned, confiscated the illegal gains, and fined 233,000 yuan. The health management company involved in the case was also fined 914,000 yuan in accordance with the law.
In June 2022, the Sichuan Provincial Health Commission announced the top ten typical cases of health administrative penalties in 2021, in which it was verified that a traditional Chinese medicine hospital in Bazhong City rented out the lithotripsy department to non-personnel of the institution to carry out extracorporeal shock wave lithotripsy diagnosis and treatment activities, and obtained a commission income of 65,400 yuan, was fined 3,500 yuan, and confiscated 65,400 yuan of illegal income. A separate case will be handled for the personnel of the contracted lithotripsy section.
In severe cases, the person in charge of the medical institution may also be sentenced. In December 2023, the Supreme People's Court disclosed a tragedy caused by a department's contracting. As the legal representative of a hospital in Jinjiang City, Fujian Province, Wu Moujuan knew that others did not have medical qualifications but still contracted the hospital clinic to cause death, and was investigated for criminal responsibility, and finally the court sentenced Wu Moujuan to three years in prison and a fine of 50,000 yuan for illegal medical practice.
"Department contracting" is the red line, bottom line and high voltage line of the medical industry. The Basic Medical Care and Health Promotion Law of the People's Republic of China, which came into effect on June 1, 2020, clearly stipulates that medical and health institutions shall not lease or contract medical departments. Where the provisions of this Law are violated, the competent health department of the people's government at or above the county level shall order corrections, confiscate the unlawful gains, and impose a fine of not less than 2 times but not more than 10 times the amount of the unlawful gains, and where the unlawful gains are less than 10,000 yuan, it shall be calculated as 10,000 yuan;
For medical institutions, leasing and contracting departments will not only face severe punishment by laws and regulations, but also affect their grade evaluation. Among them, the pre-requirements of the "Evaluation Standards for Tertiary Hospitals (2022 Edition)" stipulate that if one or more situations occur in the hospital during the review cycle, the review will be postponed for one year. During the postponement period, the original rank will be cancelled and managed according to the "undecided". The first of these pre-requisites is to set up and practice in accordance with the law, which clearly mentions that "medical and health institutions lease or contract medical departments".
Lawyer's statement: how to define "department co-construction" and "department contracting".
Shao Yingfang is a senior partner of equity at Beijing Yingke (Shanghai) Law Firm
Mainland law clearly prohibits medical institutions from leasing relevant licenses, and strictly prohibits "department contracting". At the same time, the relevant national policies clearly encourage social forces to explore and carry out hospital management, and deepen medical reform through the form of "department co-construction". Many medical entrepreneurs are confused: what is the difference between department contracting and department co-construction, how to define its boundaries, and how to avoid accidentally falling into a minefield?
First of all, we must understand the definition of department contracting, which appears in the "Ministry of Health's reply on the application of law in the special rectification work of illegal blood and apheresis and illegal medical practice", and the concept of "department contracting" is defined as: a medical institution contracts or leases a department or house to a person who is not the medical institution or other institutions and carries out diagnosis and treatment activities in the name of the medical institution.
In practice, there are two main modes of department contracting:
(1) Medical establishments hand over their departments to non-personnel of the institution or other institutions, operate independently, bear their own profits and losses, and carry out diagnosis and treatment activities in the name of the medical establishment;
(2) The medical institution hands over part of the premises of the institution to non-personnel of the institution, agrees to set up corresponding departments in the medical institution, or agrees to set up corresponding medical departments outside the medical institution in the name of the medical institution, operates independently, and carries out diagnosis and treatment activities in the name of the medical institution. This model should essentially be attributed to the act of leasing or lending the "Medical Institution Practice License".
Let's take a look at the definition of department co-construction:
(1) The co-construction departments under the mode of department co-construction and cooperation are under the top-down management system of the hospital from beginning to end, and are fully integrated into the unified management of the hospital. The partner does not participate in the distribution of the hospital's profits, but charges a fixed monthly management fee or service fee.
(2) Under the department co-construction model, the role of social medical institutions is to participate in management, and the cooperation with hospitals is a model of complementary advantages. For example, a group of doctors with abundant expert resources has established departments with grassroots hospitals to provide technical training to grassroots hospitals, and social forces that are good at hospital management and operation have reached cooperation with hospitals to provide scientific and efficient management services.
Through the above definition and analysis of the model of "department contracting" and "department co-construction", it is obvious that the main difference between department contracting and department co-construction is whether the department operates independently of the hospital, especially the public hospital, which is a non-profit institution, and the balance of income and expenditure in operation can only be used for its own development and cannot distribute profits.
In practice, it is common to judge whether the cooperation model is a prohibited "department contracting" or an encouraged "department co-construction" based on the following actual circumstances:
(1) Formality
1. The type of contract signed.
If the contract or lease contract is clearly signed, it is easy to be considered that there is a problem of "department contracting", but if the two parties sign a "cooperation contract" or a "department co-construction contract", further judgment is required;
2. Registration of medical staff.
If it is found that the practice location, personnel relationship, labor or labor relationship of the medical staff are not in the cooperative hospital during the ordinary inspection process, they will be considered to have the problem of "department contracting", and at the same time, the medical staff may have the problem of illegal medical practice, and will receive administrative penalties from the relevant departments. Therefore, the legal co-construction of departments should register the medical staff in the cooperative hospital.
(2) Substantive aspects
1. Whether the financial revenue and expenditure are included in the unified management.
If the cooperative hospital sets up a separate settlement account, it is not actually controlled by the cooperative hospital, or if the words "rent" and other words are clearly listed in the financial account, it is a typical "department contract". Therefore, the operation and management of the joint construction of the department must be incorporated into the unified financial management of the hospital.
2. Collect fees privately.
Some hospitals set up hospitals within hospitals, and the income of some departments is not carried out through the hospital at all, but is collected by a third-party management company, which will be regarded as a typical "department contracting" in practice, and the opposite party of the medical behavior is a medical institution with medical practice qualifications and patients, and there is a medical service contract relationship between them, and the management company does not have the qualification to collect diagnosis and treatment service fees. Therefore, the joint construction of departments must not be charged privately.
Therefore, at the very beginning of cooperation, we should pay attention to not accidentally stepping into a minefield and causing unnecessary losses to the enterprise.
Medical and health undertakings are directly related to the health and life safety of the people, and only by continuously exploring various modes of cooperation between social forces and public hospitals under the premise of ensuring medical safety and quality can we truly inject fresh blood into medical reform and promote the flow of high-quality medical resources. (This article is published by "Seeing the Medical World", and reprinting must be authorized, and the author and source should be indicated at the beginning of the article.) ）