Health

Six departments jointly carry out special rectification of illegal and irregular issues in medical insurance funds

2024-04-18   

Recently, the National Medical Insurance Administration, in conjunction with the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, and the National Health Commission, issued the "2024 Special Rectification Plan for Illegal and Non compliant Issues in Medical Insurance Funds", carrying out special rectification work on illegal and non compliant issues in medical insurance funds nationwide. The plan emphasizes adhering to a problem oriented approach and highlighting the focus of rectification. One is to focus on fraudulent and fraudulent behaviors such as false diagnosis and treatment, false purchase of drugs, and reselling medical insurance drugs, and carry out strict crackdowns. The second is to focus on key drug consumables with large amounts of medical insurance fund usage and abnormal changes, dynamically monitor fund usage, and focus on investigating and punishing fraudulent insurance practices. Thirdly, we will focus on key areas such as orthopedics, hemodialysis, endocardial examination, testing, and rehabilitation therapy, and comprehensively carry out self-examination and self correction. The plan emphasizes the principle of balancing leniency and severity, and classifying and disposing of cases in accordance with the law. Serious punishment shall be imposed in accordance with the law for heinous acts of fraud and insurance fraud. For general violations of laws and regulations, with the main purpose of standardization, we will comprehensively use protocol and administrative measures to continuously promote problem rectification. The National Medical Insurance Administration will formulate a list of relevant issues in the field, supervise and guide designated medical institutions to conduct self inspection and self correction in comparison. The plan emphasizes adhering to integrity and innovation, and strengthening data empowerment. Adhere to the combination of traditional regulatory methods and modern regulatory methods. The National Medical Insurance Administration will continue to play the role of validated and effective big data models, screen and analyze emerging, biased, and trending issues, and achieve precise strikes. Carry out pilot work on the application of anti fraud big data supervision in medical insurance, explore the application of drug traceability codes in the supervision of medical insurance funds, accelerate the construction of more efficient and effective big data models, and promote breakthrough progress in big data supervision. (Lai Xin She)

Edit:GuoGuo Responsible editor:FangZhiYou

Source:gmw.cn

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