13 provinces have landed, and the national flight inspection is coming
On July 19, the 2024 National Medical Security Fund Unannounced Inspection Kick-off Meeting was held in Hohhot.
At the meeting, the People's Hospital of Inner Mongolia Autonomous Region, Ren Zhigang Traditional Chinese Medicine Hospital of Wuchuan County, Sino-Mongolian Hospital of Qingshuihe County, Saihan District Hospital of Hohhot City, and Sinopharm Guoda Pharmacy Inner Mongolia Co., Ltd. were identified as the inspected institutions in Hohhot.
On July 20, the national flight inspection team went to Ulanqab City to hold a kick-off meeting. At the meeting, it was determined that Ulanqab Central Hospital, Ulanqab Xintexin Pharmacy Chain Co., Ltd. and 3 private designated medical institutions were inspected institutions in Ulanqab City.
Not only Inner Mongolia, since July, the national medical insurance flight inspection team has reached four new provinces:
Tibet Autonomous Region
On July 17, the kick-off meeting of the 2024 National Medical Security Fund unannounced inspection of the Tibet Autonomous Region was held in Lhasa. The national flight inspection team will inspect the use and management of medical insurance funds and the construction and implementation of relevant internal control systems in 2022-2023 of 2 designated medical institutions and 1 designated chain pharmacy; A "retrospective" review of one designated medical institution that had previously undergone national unannounced inspections was conducted.
Anhui Province
On July 9, the 2024 National Medical Security Fund Unannounced Inspection Anhui Provincial Kick-off Meeting was held at the Hefei Municipal Convention Center, and the list of 3 inspected institutions in Hefei was determined on the spot.
Shanxi Province
On July 2, the 2024 National Medical Security Fund Unannounced Inspection Shanxi Provincial Kick-off Meeting was held in Taiyuan. The unannounced inspection will inspect 4 designated medical institutions and 2 designated chain pharmacies in Taiyuan and Jincheng cities.
Up to now, the national flight inspection team has successively landed in 13 provinces of Henan, Hainan, Liaoning, Jilin, Zhejiang, Shandong, Sichuan, Hunan, Yunnan, Shanxi, Anhui, Tibet and Inner Mongolia, and has clarified the key points of inspection.
And at the same time as the national flight inspection is carried out, the provincial flight inspection is also closely cooperating. In the past month or so, the inspection teams of various provinces and cities have completed their settlement, and the medical insurance flight inspection action in 2024 is entering the climax!
More than 30 flight inspection teams are airborne!
A large number of hospitals were raided and inspected
According to the Hongkou District Medical Insurance Bureau, the Shanghai Hongkou and Jing'an Medical Insurance Joint Inspection Team conducted unannounced inspections on the Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai Qinghewan Rehabilitation Hospital, Shanghai Good Pharmacist Xiangteng Pharmacy, and Shanghai Yunhu Pharmaceutical Chain Management Co., Ltd. Yishouchun Pharmacy in 2024.
Coincidentally, the joint medical insurance inspection teams of Shanghai Pudong New Area and Chongming District carried out a five-day unannounced inspection of four designated medical institutions: Yangpu District Mental Health Center, Shanghai Riyuexing Nursing Home, Shanghai Guoda Dongshengda Pharmacy Co., Ltd., and Shanghai First Medical Store Chain Management Co., Ltd. Linglin Pharmacy.
It is reported that the two inspection teams are composed of medical experts from the medical insurance bureaus of various districts, the health commission, and third-party service agencies, with a scale of 26 and more than 30 people respectively.
In addition to Shanghai, on the afternoon of July 20, the special flight inspection of the 2024 Henan Provincial Medical Insurance Fund was also fully launched.
The inspection time is one month, 305 experts and business backbones are selected to form 9 inspection teams, combined with big data analysis and the issuance of suspicious clues to determine the inspected medical institutions, and take no notice, no greeting, no report, no accompanying reception, go straight to the grassroots, go straight to the scene "four nos and two straights" to carry out on-site inspections in two batches.
On June 19, Hainan Province clarified that this year's inspection objects include 16 designated medical institutions and 2 designated retail pharmacies, which will be established to focus on inspecting the use and management of medical insurance funds from January 1, 2022 to December 31, 2023.
On June 13, the 2024 Sichuan Provincial Medical Insurance Fund Flight Inspection Kick-off Meeting was held simultaneously in Neijiang, Deyang, Leshan, and Liangshan, and it was clear that a total of 22 inspection teams were set up for this flight inspection to carry out flight inspections on more than 130 medical institutions in the province, and the on-site inspection will last from June to September.
Obviously, with the end of the inspection teams in various places, the storm of strict investigation is about to break out, so where is the focus of this year's rectification?
Focus on strict investigation of 67 behaviors (with list),
Repeated, interchangeable, over-standard charges...
On July 12, the official website of the National Health Insurance Administration updated the "Flight Inspection is in progress, and we are strictly investigating these behaviors!" The article answers this question exactly.
In this article, the National Health Insurance Administration officially issued the "List of Typical Issues in the Illegal Use of Medical Security Funds by Designated Medical Institutions" (2024 Edition), which has a total of 67 items in six categories, and sorts out the typical problems of common violations of laws and regulations in six fields.
Through the list, it can be found that the scope of this year's medical insurance flight inspection is very comprehensive and goes straight to the details, and some more hidden or varied violations will have nowhere to hide.
For example, in the orthopedic category, a series of behaviors such as "different manufacturers, different specifications, and different prices of orthopedic high-value consumables are exchanged for each other", "the artificial joints and internal fixation materials used in a complete set are split into a single component and charged, and the sum of the fees charged for a single component is greater than the complete set of fees" and other series of behaviors are named.
With the simultaneous advancement of the national and local provincial and municipal rectification, hospitals across the country will usher in a thorough "penetrating" inspection, and dig out a number of "big and important cases" hidden in the depths and an astonishing amount of money.......
The full list of typical questions is as follows: