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At the end of November, a patient's family member provided a special medical insurance regulatory notice to the Economic Observer. According to the notice, the medical insurance departments of Anhui Province and Wuhu City recovered 18690,000 yuan of medical insurance**, and a penalty of 560,000 yuan in liquidated damages. At the same time, the Second People's Hospital of Wuhu City refunded 3$120,000 for out-of-pocket expenses.
According to the patient's family, the mother and aunt of the whistleblower were the first to discover that the Second Hospital of Wuhu City might have violated laws and regulations. The informant's mother went to the ICU gate of the hospital every night to wait for ** to pick up the clean towels she had prepared for her husband, and each time asked **about her husband's condition and whether he was on dialysis**.
The informant's aunt is an experienced accountant who is responsible for paying the hospital on a daily basis and will ask the ICU ** to provide a list of the fee balance so that the approximate fee balance can be understood. After accumulating dozens of these lists, she made an excel**, which calculated the approximate proportion of her daily out-of-pocket expenses according to the national medical insurance catalog and the relevant policies of Wuhu City's medical insurance payment.
On November 28, the relevant staff of the Wuhu Municipal Medical Insurance Bureau and the Wuhu Second People's Hospital confirmed this information. At present, the Health Insurance Bureau has transferred the case to the public security organs and health departments for handling.
The report letter lists a number of cases of illegal hospital charges, including:
Suspected of fictitious number of enteral feeder perfusions. Hospital invoice records show that patients received 1083 enteral infusions, with an average of 10 perfusions per day31 times. According to the criteria of the Consensus on Clinical Pharmacy in Enteral Nutrition (Second Edition), the number of infusions of enteral nutrition should be 4-6 times per day. As a result, the patient's family estimated the hospital overcharge for this alone230,000-310,000 yuan.
Suspected of colluding in the exchange of drugs and including medical expenses that are not within the scope of medical insurance** payment into the settlement of medical insurance**. The discharge statement shows that polymyxin e sodium mesylate is settled according to medical insurance, totaling 15,984 yuan.
Suspected of fictitious hemodialysis monitoring time. The hemodialysis monitoring time was 6975 hours, much higher than the continuous blood purification time of 433 hours, involves a cost of 10,580 yuan.
This incident is a warning for the majority of patients and their families. Patients and their families should take care to review the billing list and bills to ensure that the charges are reasonable and transparent. At the same time, patients and their families should promptly report and complain to the relevant departments about the irregularities and excessive charges in the hospital to protect their legitimate rights and interests.
In addition, hospitals should also strengthen self-discipline and management. As an important institution for providing medical services, hospitals should comply with laws, regulations and ethics to protect the rights and interests of patients. For the existing violations and excessive charges, the hospital should take the initiative to rectify and compensate to establish a good image and social reputation.
In short, the incident of overcharging patients' medical fees by Anhui tertiary hospitals has aroused widespread social attention and discussion. The incident reminds us that we should pay attention to protecting our own rights and interests when receiving medical services, and at the same time, we need to strengthen the management and service quality of hospitals. It is hoped that the relevant departments can conduct an in-depth investigation and handling of this matter, and provide a more fair, transparent and reasonable medical service environment for the majority of patients.
The hospital overcharged the patient 210,000 yuan in medical expenses
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