Under the intelligent supervision mode, the national hospital inspection presents a new situation, and some hospitals have been notified.
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Seven provinces launched national flight inspections
Regulatory Intensity "Unprecedented"
In 2024, the supervision and efficiency of medical insurance flight inspection will reach an unusually new height. In just over a month, the national medical insurance flight inspection team has reached 7 provinces.
On June 24, the 2024 National Medical Security Fund Unannounced Inspection Sichuan Provincial Kick-off Meeting was held in Chengdu. Among them, West China Hospital of Sichuan University, Chengdu Pidu Huayi Kangsheng Hospital Co., Ltd., and Sinopharm Southwest Pharmaceutical Co., Ltd. were designated, and the Sichuan Provincial Maternal and Child Health Hospital was determined by lottery as the 2024 National Medical Security Fund flight inspection institution in Sichuan Province.
On June 25, the kick-off meeting of the 2024 National Medical Security Fund unannounced inspection in Guangyuan City was held. At the meeting, it was determined that the inspection time was from June 25 to July 10, and the inspection objects were Guangyuan Central Hospital, Wangcang Jiashi Rehabilitation Hospital, and Guangyuan Zhixin Pharmacy Chain Co., Ltd.
On June 22, the sixth kick-off meeting of the 2024 National Medical Security Fund unannounced inspection was held in Jinan, Shandong Province.
At the meeting, it was proposed that unannounced inspection is one of the most powerful work measures in the supervision of medical security funds, and it is necessary to always adhere to the more serious problems, constantly broaden the coverage of inspections, fairly and impartially supervise and inspect the main body of various medical insurance funds, and deal with and punish all kinds of violations of laws and regulations in accordance with the principle of leniency and severity.
Up to now, Henan, Hainan, Liaoning, Jilin, Zhejiang, Shandong, and Sichuan have all held the 2024 National Medical Security Fund Unannounced Inspection Kick-off Meeting. Among them, Hainan was selected to carry out the first national flight inspection "looking back", and one institution that had received the national flight inspection has been randomly selected as the inspected agency.
(Drafting: Cyberblue Equipment)
In this round of national medical insurance flight inspection, Henan is the first province to start the inspection. Just over a month after the inspection began, the official WeChat of the National Health Insurance Administration disclosed the suspected fraud and insurance fraud of two hospitals in Henan.
The National Health Insurance Administration made it clear that in the next step, it will continue to pay close attention to the follow-up disposal of the case to ensure that the investigation and punishment of fraud and insurance fraud cases are in place, and the illegal and criminal elements are severely cracked down.
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Focus on investigating and dealing with the five major aspects of the hospital
Provincial flight inspection is carried out simultaneously
According to a recent article in the China Discipline Inspection and Supervision Daily, the discipline inspection and supervision team of the Central Commission for Discipline Inspection and the State Supervision Commission in the National Health Commission has strengthened normalized communication with the National Health Insurance Bureau, supervised and further broadened the coverage of medical insurance unannounced inspections, organized medical institutions to carry out self-examination and self-correction against the list of problems before unannounced inspections, and strengthened the follow-up punishment of unannounced inspections and the scheduling guidance of cases to promote reform and treatment.
In this year's medical insurance flight inspection, the number of cities inspected has increased from 1 to 2 per province per year, of which all provincial capitals must be checked; The number of medical institutions inspected is about three times the average level of previous years, and the number of inspection subjects has shifted from public hospitals to public hospitals, private hospitals, and retail pharmacies.
Among them, for designated medical institutions, focus on five aspects:
(Screenshot from the official website of the National Health Insurance Administration)
At the same time, unannounced inspections of provincial medical security funds at the local level are also advancing rapidly.
On the morning of June 24, the first flight inspection team in Hainan was stationed in Hainan Orthopaedic Hospital to carry out inspections, and the provincial flight inspection of the province's 2024 medical insurance fund was officially launched. The inspected institutions are mainly selected from the designated medical institutions above the second level that have not accepted the national or provincial flight inspection (including provincial special and special case inspections) in the past three years, including 16 designated medical institutions and 2 designated retail pharmacies. On-site inspections are expected to continue until the end of August.
On June 14, the first batch of medical insurance fund flight inspection teams in Yunnan Province in 2024 was officially stationed in Pu'er City. According to the work arrangement, the 2024 Yunnan provincial unannounced inspection will cover all co-ordinated areas, and the number of inspection agencies and geography will be more extensive than in previous years.
This month, the 2024 Sichuan Provincial Medical Security Fund unannounced inspection kick-off meeting was held, and the unannounced inspection will achieve full coverage of 21 cities (prefectures), and a total of 22 inspection teams will be set up to carry out unannounced inspections of more than 130 medical institutions in the province.
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Massive data "dragnet" checking
Intelligent supervision has achieved initial results
At present, the inspection area of medical insurance flight inspection has expanded, and intelligent means have raised the level of supervision to a new height.
According to the disclosure of the National Health Insurance Administration, this year, the National Health Insurance Administration has strengthened the application of big data screening methods in the supervision of medical insurance funds, and severely cracked down on all kinds of fraud and insurance fraud.
From May 11 to 23, 2024, the national flight inspection team inspected some designated medical institutions in Zhengzhou City and Zhoukou City, Henan Province. In advance, the National Health Insurance Bureau used a big data model to screen the data used by the medical insurance fund of the inspected city, and according to suspicious clues, Zhengzhou Guancheng Yufeng Hospital and Zhoukou Shangshui Qingkang Hospital were designated as the inspected institutions, and the problem of suspected fraud and insurance fraud was initially found.
In the aforementioned article, the relevant responsible comrades of the Discipline Inspection and Supervision Group of the National Health Commission said, "We promote the National Health Insurance Bureau to build a whole-process supervision line of defense, establish a working mechanism for supervision to people, study the medical insurance payment qualification management system for relevant personnel of designated medical institutions, establish a typical case notification mechanism according to the characteristics of different types of designated institutions, rely on the medical insurance information system to develop a big data supervision model, and conduct a dragnet investigation on massive settlement data to achieve precise strikes." Refine and improve the standards, time limits, content, and forms for transferring leads to discipline inspection and supervision organs, and further clarify the linkage and cooperation mechanisms between discipline inspection and supervision organs and medical insurance departments. ”
According to reports, the National Health Insurance Administration has launched the application of medical insurance fund supervision and administrative law enforcement, report and complaint acceptance, flight inspection and other systems to achieve online traces of the whole process of work, traceability of processing results, reduce human intervention, and ensure the institutionalization, standardization and transparency of medical insurance fund supervision.
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