On April 28, the National Health Insurance Administration, the Ministry of Finance, the National Health Commission, and the State Administration of Traditional Chinese Medicine issued the "Notice on Carrying out the Unannounced Inspection of the Medical Security Fund in 2024" (hereinafter referred to as the "Notice") to carry out the unannounced inspection of the Medical Security Fund in 2024 nationwide.
In 2024, the national flight inspection will further increase the scope of random inspection cities. In principle, the number of cities to be inspected in each province has increased from one to two per province per year, and the capital cities of each province must be checked. In addition, the national unannounced inspection adheres to the full coverage of institutional types, and each province simultaneously inspects a certain number of public designated medical institutions, private designated medical institutions and designated retail pharmacies.
In addition, in 2024, the national flight inspection will be carried out for the first time to carry out a "look back". This year, a certain percentage of the designated medical institutions that have been inspected by flights in previous years will be selected for a "retrospective". The main consideration of this measure is to avoid the institutions that have been checked that they will not be checked again in a few years, and there will be slack ideas in standardizing the use of medical insurance funds, and guiding designated institutions to strengthen internal management and standardize the use of funds as active awareness and conscious action.
In terms of inspection content, the "Notice" clarifies that the focus will be on the use and management of the medical insurance fund and the construction and implementation of relevant internal control systems during the period from January 1, 2022 to December 31, 2023, and retrospectively inspect the previous year or extend the inspection to 2024 if necessary.
▶ For designated medical institutions, focus on five aspects:
The first is to focus on the fields of critical care medicine, anesthesia, lung tumors, etc., investigate and deal with the illegal use of medical insurance funds, and focus on investigating and dealing with fraud and insurance fraud.
The second is to focus on cardiovascular medicine, orthopedics, blood purification, rehabilitation, medical imaging, clinical testing and other areas that have been key to inspection and self-examination and self-correction in previous years, and check whether they are self-inspected and rectified as required.
The third is to focus on whether the problems found in the previous annual inspection still exist and whether the rectification is in place.
The fourth is to focus on the online procurement of drug consumables, focusing on whether public medical institutions purchase all the required drug consumables on the provincial centralized procurement platform in accordance with the regulations.
Fifth, for patients who are admitted to other provinces and places for medical treatment, check whether there is any illegal use of medical insurance funds.
▶ For designated retail pharmacies, focus on three aspects:
The first is the false purchase of medicines. Falsifying prescriptions or expense lists, emptying or stealing medical insurance cards or medical insurance electronic vouchers.
The second is to participate in the resale of medical insurance drugs.
The third is to exchange drugs. Replace drugs or other commodities that are not paid by the medical insurance fund with medical insurance drugs for medical insurance settlement, and forge or alter the bills and accounts of "purchase, sale and storage" of medical insurance drugs.
It is understood that the national unannounced inspection is carried out in the mode of "national organization, provincial crossing, and territorial cooperation". At the national level, it is responsible for formulating inspection plans, organizing inspection work, strengthening guidance and supervision of the whole process of inspection, and strengthening the work of "above and below". Cross-checking was carried out between different provinces by random matching. The province participating in the inspection is responsible for organizing the inspection force and carrying out the on-site inspection; the inspected province is responsible for cooperating with the preparation, organization, and implementation of the inspection, organizing the self-inspection and self-correction before the on-site inspection, and the disposal and rectification after the inspection, so as to strengthen the fairness and impartiality of the supervision and inspection.
Full text of the Notice
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Edit | Zhang Zhiying Editor-in-charge| Zhang Xiuli
Integrated Sources | Official website of the National Medical Security Administration, Beijing Daily
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