Dazhou full record! Irregular delivery benefits!
Repeated charges, hanging beds for hospitalization
Swap items, over-standard and split charges
Fake invoices are repeatedly reimbursed to medicare funds
……
In accordance with the unified deployment of the province and the city, the city has carried out special governance of prominent problems in the field of medical security and special governance actions to combat the "three falsehoods".
Yesterday, the Dazhou Municipal Medical Security Bureau reported seven typical cases of violations:
01 Fuji Hospital duplicate charges
After investigation, from January to May 2020, Fuji Hospital had violations such as duplicate charges, irrational use of drugs, and unreasonable inspections, involving a total of 47,311.95 yuan in medical insurance funds. In accordance with the relevant provisions of the "Medical Security Designated Medical Institution Service Agreement", Tongchuan District recovered all the illegal medical insurance funds and interviewed the main responsible person of the hospital.
02 Tingzi Town Center Health Center in Dachuan District hanging bed hospitalization, duplicate fee case
After investigation, from January to December 2020, the Tingzi Town Center Health Center in Dachuan District had irregularities such as hanging bed hospitalization, unintended medication, and repeated payment, involving a total of 292187.75 yuan in medical insurance funds. In accordance with the relevant provisions of the "Service Agreement for Designated Medical Institutions on Medical Security", Dachuan District recovered all the illegal amounts and interviewed the relevant responsible persons of the hospital, and at the same time handed over the clues of the relevant problems to the health department and the health and health discipline inspection team.
03 Song Moumou of Yudai Township, Wanyuan City, concealed the trauma through the fraud insurance case
After investigation, Song Moumou was treated for trauma in April 2019, and the people's government of Yudai Township of Wanyuan City issued a trauma investigation certificate, and the injury was originally due to accidentally falling down picking up "salt vegetables" in his own home, and the medical insurance fund paid 37012.78 yuan. The Wanyuan Municipal Medical Insurance Bureau found in the routine verification of the hospitalization of external injuries that according to the description of the medical records, the skin of Song Moumou's thigh was torn in a large area, which was inconsistent with the injuries caused by the fall. After on-site investigation and visits, it was found that Song Moumou's trauma accident was that he himself fell on a two-wheeled motorcycle of others on the village road of Mengjiazhai Village, Yudai Township, Wanyuan City. The Wanyuan Municipal Medical Insurance Bureau has recovered 37,012.78 yuan from the medical insurance fund, and the government staff and village cadres of Yudai Township in Wanyuan City have been dealt with by the organization for providing false certificates.
04 Xuanhan County Tuhuang Town Health Center collusion project, exceeding the standard and decomposition of charges
After investigation, from January to December 2020, the Tuhuang Town Health Center in Xuanhan County had violations such as decomposition charges, over-standard charges, and collusion of items, involving a total of 808454 yuan of medical insurance funds. In accordance with the relevant provisions of the "Service Agreement for Designated Medical Institutions for Medical Security", Xuanhan County recovered all the illegal amounts, interviewed the main responsible persons of the hospital, ordered rectification within a time limit, and at the same time handed over the clues of the violations to the discipline inspection team of the County Discipline Inspection Commission Supervision Commission in the Health and Health Bureau.
05 Dazhu County Zhu Moumou forged fake invoices and repeatedly reimbursed the medical insurance fund
After investigation, Zhu Moumou, an insured resident of Dazhu County, forged false invoices from 2018 to 2020 in Dazhu County Medical Security Affairs Center to manually reimburse Chengdu High-tech Boli Hospital for 8 hospitalizations, defrauding the medical insurance fund of 65259.03 yuan. At present, the case has been filed and investigated by the public security organs.
06 Quxian Lu moumou repeated reimbursement of medical insurance funds
After investigation, Lu Moumou, an insured resident of Quxian County, from January to August 2018, after the medical insurance network settlement was carried out in the medical institutions in the place of treatment, he still returned to the insured place for reimbursement, involving a total amount of 18317.71 yuan. After repeated reminders from the Quxian Medical Security Bureau, the parties refused to return the illegal medical insurance fund. It has now been handed over to the judicial authorities for handling in accordance with the law
07 Kaijiang Miaoren Hospital double charges, collusion project charges
After investigation, between January and December 2020, Kaijiang Miaoren Hospital had violations such as duplicate charges, collusion of project charges, and decomposition of charges, involving a total of 18529.5 yuan of medical insurance funds. In accordance with the relevant provisions of the "Medical Security Designated Medical Institution Service Agreement", Kaijiang County recovered all the illegal amounts and interviewed the main responsible person of the hospital, and ordered rectification within a time limit.
Source: Synthesis
Editor: Wang Jia
Editor-in-Charge: Pandan
Fu Yong
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