The municipal Health insurance bureau adopted “five strict” measures to crack down on fraud and obtain effective results

2022-05-13 0 By

Since 2021, the Municipal Medical Insurance Bureau has taken the Regulations on The Supervision and Management of The Use of Medical Security Fund as the starting point, focusing on cracking down on fraudulent insurance activities such as “fake patients”, “fake medical conditions” and “fake bills”, and adopted “five strict” measures to strengthen the supervision and audit of the fund, effectively safeguarding the interests of the masses and the safety of the fund.First, create a strict atmosphere.Will promote and implement the regulations on the supervision and administration of medical insurance fund use as a priority task in daily work, successfully hosted the city and the province held the medical insurance fund regulatory focus awareness month cloud a kick-off meeting for the scene activities, through various channels and the way out publicity materials more than 20000 copies of the whole society to form a powerful deterrent.Second, the use of “strict” means.Concentrated efforts were made to carry out the special treatment of combating “three holidays” by the municipal medical insurance fund, covering all designated medical institutions with on-site inspection, screening more than 300,000 pieces of data, sampling more than 1,500 cases, checking more than 1,000 outpatient visits, returning visits to 200 inpatients, and talking about the rectification of 25 designated medical institutions within a specified time limit.Recover violation fee of 5,068,100 yuan.Effectively cracked down on fraud and violation of regulations.Third, we will implement strict responsibilities.With the medical insurance fund “looking back” and special inspection as the starting point, implement the requirements of “clearing zero” for cases of violation item by item, strictly follow the requirements stipulated in the medical insurance service agreement, recover the rate of illegal fees of medical institutions 100%, and pay liquidated damages rate of designated medical institutions 100%.The case “Zero action” has been completed.Fourth, strengthen the “strict” network.Drew up the mr.zhang medical security and integrated supervision system (first phase) implementation plan “, start the third party professional services procurement projects, build online, multi-sectoral linkage of “integrated” fund intelligent supervision system, realize the medical insurance fund in advance, regulatory approaches closed-loop environment, enhance the level of our city medical insurance fund supervision,We will ensure the safe and sustainable development of medical insurance funds.Fifth, we need to improve our ability to be strict., which is based on business training, to carry out the second phase of fund regulatory audit orgnaization of business training, held eight period of “strengthen the fund supervision standardize medical service” policy interpretation and healthcare management practice training, training people in the city reached more than 2000 people, has trained a batch of fund supervision business backbone, efficient and accurate boost the city’s fund supervision work to a new level.Declaration: The copyright of this article belongs to the original author, if there is a source error or infringement of your legitimate rights and interests, you can contact us through the mailbox, we will promptly deal with.Email address: jpbl@jp.jiupainews.com