Sword refers to the violation of laws and regulations of the national medical insurance fund, the National Medical Insurance Bureau and other six departments held a working meeting.
01
The State Medical Insurance Bureau and other six departments held a working meeting
Medical insurance fund violations of laws and regulations special rectification is imminent
On April 8, the National Medical Insurance Administration, the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance and the National Health Commission jointly held a special conference on the remediation of violations of laws and regulations of the National Medical Insurance Fund in 2024.
The special rectification of violations of laws and regulations of the National Medical Insurance Fund in 2024 will highlight six key points, including focusing on the rectification of medical insurance flight inspection and corruption in the medical field.
In recent years, the high pressure situation of medical insurance fund supervision has increased.
In April 2023, the State Medical Insurance Bureau and other five departments carried out special rectification work to combat fraud in the medical insurance field; In May of the same year, The General Office of the State Council issued the Implementation Opinions on Strengthening the Regular Supervision of the Use of Medical Security Funds; In July of the same year, the State Medical Insurance Bureau and other four departments issued the "Notice on carrying out Flight Inspection Work of Medical security Fund in 2023" to strengthen the normal supervision of the use of medical insurance fund.
In January, the National Medical security work Conference made it clear that in 2024, the high-pressure situation of fund supervision should be strengthened. Achieve comprehensive coverage of on-site supervision, precision strikes of off-site supervision, and give full play to the searchlight role of governance of corruption in the pharmaceutical field.
Entering 2024, from the signal that the supervision of medical insurance fund is high-frequency in the series of work meetings of the Medical insurance Bureau, 2024 will undoubtedly be a big year for the supervision of medical insurance fund.
It is worth noting that the medical anti-corruption will continue in 2024, and the related issues of the use of medical insurance funds are also one of the focuses of the concentrated remediation of corruption in the national medical field.
As a searchlight for corruption in the field of medicine, the supervision of medical insurance funds may also lead to hidden corruption in the field of medicine.
What will be the new trend of healthcare fund regulation in 2024?
Regarding the meeting on April 8, from the perspective of participating departments, the relevant staff of the discipline inspection and supervision team of the National Health Commission, the Ministry of Justice, the Ministry of Finance, the Audit Office, the General Administration of Market Regulation, the State Administration of Traditional Chinese Medicine, and the State Food and Drug Administration attended the main venue. Provincial (autonomous region, city) and Xinjiang Production and Construction Corps medical insurance bureau, people's court, people's procuratorate, Public Security department (bureau), Department of Finance (bureau), health commission and other units in charge of the participants in the sub-venue.
It seems that while the participating departments of medical anti-corruption and rectification have expanded to 14 departments, the government forces involved in the supervision of medical insurance funds are also gradually strengthening.
02
A new round of national health insurance flight checks is coming
The net of health care is creeping back to a heavy-handed regulatory regime
The unannounced flight inspection has become an important starting point for improving the supervision system of medical insurance fund. The special regulation of the medical insurance fund in 2024 requires the strengthening of flight inspections, especially for designated medical institutions.
From the cases reported in the past, the behavior of designated medical institutions to cheat insurance gradually changed from explicit to recessive - for example, the use of some medical service project connotation, pricing units, excluded content and description of vague, repeated charges, application of project charges, overstandard charges, etc.
In June 2023, The State Council Information Office held a regular briefing on the policy of The State Council also mentioned that the "blatant" fraud of designated medical institutions has been curbed, but the phenomenon of "running and leaking" is still relatively common, the means of fraud are more concealed and more professional, fraud and medical corruption are intertwined, and the difficulty of supervision is increasing.
In line with the high-pressure situation of medical insurance fund supervision, the punishment of medical insurance fraud was strengthened.
In March 2024, the Supreme People's Court, the Supreme People's Procuratorate, and the Ministry of Public Security issued the "Guiding Opinions on Several Issues concerning the Handling of Criminal Cases of Medical Insurance Fraud" notice that designated medical institutions (medical institutions, drug distributors), with the purpose of illegal possession, carry out one of the following acts to defraud the medical security fund expenditure, the organization, planning, implementation personnel, In accordance with Article 266 of the Criminal Law,
Be convicted and punished for fraud; If it also constitutes other crimes, it shall be convicted and punished in accordance with the provisions of heavier punishment:
Intelligent supervision is another main means of medical insurance fund supervision. In order to accurately crack down on the illegal use of medical insurance funds, the National Medical Insurance Bureau is building a strict big data supervision system, while promoting the intelligent review and monitoring of medical insurance, and the intelligent supervision subsystem of medical insurance is covering more coordination areas.
According to the requirements of the National Medical Insurance Bureau, by the end of 2023, all the overall planning regions will line up the intelligent supervision subsystem, and the national medical insurance intelligent monitoring "a network" will be gradually woven.
With the rollout of the medical insurance eye, the former, middle and later series of behaviors used by the medical insurance fund are within the scope of supervision, and the regulatory defense line of the medical insurance fund will be tightly woven and dense.
The intelligent audit and monitoring system has become the "first line of defense" for the safe and standardized use of medical insurance funds by medical institutions. Medical institutions can automatically remind and intercept obvious violations of medical personnel through intelligent monitoring, and remind suspicious violations in real time.
At the same time, the offline monitoring is also strengthening, many local medical insurance departments can release the information that the masses can report and clarify the relevant incentive implementation measures, Fujian Province will be the reward amount pulled to a new high - the report of all illegal use of medical insurance funds into the scope of the reward, the eligible whistleblower according to a certain proportion of the case value to give a one-time financial reward. The maximum is not more than 200,000 etc.
The big year of medical insurance regulation in 2024 has arrived, and the concentrated rectification of medical corruption is also continuing.
Source: Cyberlan
