People often call medical insurance "life-saving money", because it is related to the well-being of the people, and it is the duty of all parties in medical and health care to keep and use it well. A few days ago, the relevant departments of the Second People's Hospital of Wuhu City, Anhui Province, a case of infringing on the interests of patients and arbitraging medical insurance were investigated and dealt with, and after verification, 10 of the 15 problems involved in the report were basically true, involving a total of 21 medical expenses in violation of regulations820,000 yuan, of which 18700,000 yuan. At present, according to the medical insurance service agreement signed by the hospital, the city's medical insurance bureau has fully recovered the medical insurance ** used in violation of regulations, interviewed the relevant person in charge of the hospital, and handed it over to the public security and health departments for further verification and processing, and the relevant administrative punishment procedures were also launched at the same time.
Why is there so much attention to this medical insurance case?First, if the truth is not revealed, who can believe that this happened to a public tertiary hospital;Second, if you don't have a high degree of vigilance and don't have the professional knowledge and background of the family members involved, let alone the success of rights protection, I'm afraid you won't even be able to find out about it.
This is precisely where the case detonated public opinion - at the beginning, when the patient's son, a doctor with no medical background but training in economics, became suspicious of the hospital expenses collected by his aunt, and then entered the hospital's paper invoices, detailed lists and "one-day hospitalization" and other information into excel to make panel data, and then used statistical software to analyze, and finally found that the father's inpatient medical project was abnormal and reported it to the higher authorities. Judging from the verified situation, the existence of excessive diagnosis and treatment, excessive inspection, excessive prescription of drugs, repeated charges, application charges, excessive standard charges, etc., all kinds of "up and down" can be called all-enabled. Judging from the list of responsible persons who have been handled, from the chief of the case to the director of the intensive care medicine department, and then to the director of the medical insurance office of the hospital with regulatory responsibility, etc., they are almost "one-stop" involved.
Now, the local provincial and municipal joint inspection team has drawn inferences from one case and decided to conduct a comprehensive extended inspection of the hospital's use of medical insurance ** in the previous year up to the time of the case. It is necessary to check back, and it is also necessary to become a "prescribed action" in the future - a patient will be stripped of more than 200,000 yuan;In total, in just over 100 days of hospitalization, the average daily charge is 2,000 yuan, which is life-saving, this is simply life-saving!I look forward to further investigation to give an explanation to the patient and society.
This incident once again sounded the alarm bell for medical insurance supervision. I have to say that it is not uncommon for medical insurance to be eaten away as "Tang monk meat" in recent years. As early as 2020, there were 223 in our country100 million yuan of medical insurance** was recovered. This year, in the typical cases of the National Health Insurance Administration, there are still illegal uses such as falsifying hospitalization records, falsifying medical records, forging bills, falsely opening diagnosis and treatment items, and false warehousing. It should be said that in recent years, the supervision of medical insurance has been strengthened, and a lot of systems have been built, such as unannounced inspections, intelligent audits and monitoring refusals, and big data model analysis to find false hospitalizations. It also reminds us that good institutional design is one thing, and responsibility is another. In fact, compared with the practice of the family members in this case, as long as the supervision is stricter and the similar diagnosis and treatment process, bills and other links can be checked in detail and in detail, the opening of "running and dripping" will not be so wide, and then completely blocked.