In this issue of the column of "Concentrated Rectification and Change", we will broadcast "Wen County: "Investigation, Reform and Treatment" to Build a "Safety Net" for the Medical Insurance Fund
The medical insurance fund is the people's "medical money" and "life-saving money", and is an important guarantee to safeguard the health rights and interests of the people, but there are still individual medical institutions or patients who regard it as "Tang monk meat", and infringe on the medical insurance fund through various new hidden means to damage the vital interests of the insured people.
Two months ago, a report reflecting the fraudulent use of employee medical insurance by individual patients for outpatient co-ordination and reimbursement attracted the attention of the staff of the discipline inspection and supervision team of the Wen County Commission for Discipline Inspection and Supervision stationed in the county health commission.
Through data comparison and on-site verification, the staff of the discipline inspection and supervision team found that Yang, a medical insurance participant for urban and rural residents in Wenxian County, used his father's employee medical insurance social security card to perform ureteral stone lithotripsy in the hospital outpatient clinic, and used the employee medical insurance outpatient clinic to reimburse 877.5 yuan.
In order to further promote the centralized rectification of unhealthy trends and corruption around the masses, the Wen County Commission for Discipline Inspection and Supervision promoted the integration of "investigation, reform and treatment", focused on outstanding problems in the medical field to carry out special rectification, and paid close attention to the outstanding problems in the medical field that the masses felt most directly and most strongly, effectively standardized the order of medical security, kept the bottom line of the safety of the medical insurance fund, and enhanced the people's sense of access to medical treatment.
With a "small incision" to promote the "big rectification", the County Commission for Discipline Inspection and Supervision and the county medical insurance, the county health commission, the county market supervision and other departments set up a special work class, list-based supervision, layers of precise accountability, through on-site inspections, intelligent audits, flight inspections, data screening, etc., for false claims and fraudulent arbitrage of medical insurance funds, focusing on illegal sales of medical insurance drugs, concealment of third-party responsibility, fraudulent use of deceased information and other problems, pressure responsibility and heavy blows.
In view of the emerging problems found in the supervision and inspection, the work team adopts the mode of "immediate supervision and handling", urges the responsible departments to establish problem ledgers, implements list-based management, and carries out "pin-type" rectification step by step; In view of the outstanding problems in the field of medical insurance, we will seriously pursue accountability and continue to deliver the deterrent effect of the crackdown. Up to now, a total of 7 cases of violations of discipline and law have been investigated and dealt with, 5 people have been punished by party discipline and government affairs, 8 people have been organized, and 318,400 yuan of medical insurance funds have been recovered.
"Through the analysis of typical cases, we have a deep understanding of the severe situation faced by the supervision of medical insurance funds and the high-pressure situation that must be maintained, and we must comply with laws and regulations and various medical insurance policies in our daily work, standardize diagnosis and treatment, and effectively improve the efficiency of medical insurance funds." Wang Moumou, a doctor in the outpatient department of the Second People's Hospital of Wen County, said.
Adhere to the combination of "immediate reform" and "long-term establishment", and realize a virtuous circle of promoting rectification through supervision, governance through rectification, and development through governance. The Wen County Commission for Discipline Inspection and Supervision adheres to the problem-oriented, educates and alerts the "people around you" with "things around you", and educates and guides medical staff to keep the bottom line and not cross the red line by holding a party branch party member meeting to read out the punishment decision on the spot, convening a warning education meeting, publicly reporting typical cases, and organizing a "family-style" clean government talk.
Wenxian Rong Media Center reporter Wang Juan correspondent Chai Lina reported