Li Lin, a native of Zhongmu County, Henan Province, has repeatedly reported in real name that Zhengzhou Muzhou Hospital (formerly the Second People's Hospital of Zhongmu County) has taken national medical insurance** in recent years, and the local medical insurance regulatory department investigated and dealt with the hospital involved in September 2022. The whistleblower was dissatisfied with the results of the investigation and punishment, and recently continued to report with his real name, which attracted widespread attention.
Xinhua Daily Telegraph reporter investigation learned that a number of hospital management personnel, including the president, of Zhengzhou Muzhou Hospital, took the lead in hedging and wantonly falsifying medical records, and many people were "hospitalized" without knowing it. In addition, Zhengzhou Muzhou Hospital is a private hospital, but it has the status of a public institutionYuan has served as the president of a private hospital for more than 10 years and is still a member of a public institution.
At present, the Zhengzhou Municipal Party Committee and the Municipal Government attach great importance to this, and have urged the Municipal Medical Security Bureau to review and review, and the public security organs are stepping up the investigation of suspected illegal clues.
Many of the hospital's management have been hospitalized, and the president has been confirmed to have hedged 13 times
Li Lin reported that from 2013 to 2021, at the instigation of the hospital's president Yuan, Zhengzhou Muzhou Hospital was fictitiously hospitalized to obtain national medical insurance**, involving more than 200 people and more than 400 times, with an amount of 178072602 yuan. In addition to ordinary patients, hospital employees, Yuan's relatives and friends, etc., the fake inpatient list also covers the president Yuan himself, the vice president, the director of the obstetrics and gynecology department, the chief of the obstetrics and gynecology department and many other hospital administrators.
The report materials provided by Li Lin listed key information such as the name, gender, hospitalization number, admission and discharge dates, name of the doctor in charge of the bed, and the amount of hospitalization of the false inpatient. Among them, President Yuan himself 19 times, Vice President Zhang 12 times, Director of the Department of Obstetrics and Gynecology Li 15 times, and Director of the Department of Obstetrics and Gynecology Zhang 19 times.
The reporter came to Zhengzhou Muzhou Hospital a few days ago and interviewed Zhang, the chief of the Department of Obstetrics and Gynecology. She confirmed that of the 19 hospitalization records in the reporting materials, except for 2 times with the same name, she admitted that the other 17 times were her own hospitalization records. In other words, from August 2014 to October 2020, Zhang was between the ages of 36 and 42 and was hospitalized 17 times in 6 years.
After receiving Li Lin's report, the local medical insurance regulatory department carried out an inspection of Zhengzhou Muzhou Hospital in September 2022. The local medical insurance regulatory department confirmed at that time that Zhengzhou Muzhou Hospital had fictitious hospitalizations for a total of 13 people and 38 times, with an amount of 17343482 yuan, of which the dean Yuan himself fictitiously was hospitalized 13 times, the vice president Zhang 4 times, and the director of the obstetrics and gynecology department Li 3 times, involving departments including obstetrics and gynecology, neurology, traditional Chinese medicine, etc.
The reporter combed and compared and found that the 38 false hospitalization records of 13 people verified by the local government in 2022 all occurred before 2019. For example, it was verified that Dean Yuan was falsely hospitalized 13 times, and Duan Li Lin reported 14 times at the same time, and the key information of the two was consistent 12 times. However, in Li Lin's reporting materials, there were at least 30 fictitious hospitalizations in Zhengzhou Muzhou Hospital after 2019, including 5 times for Yuan himself, and it is not clear whether these are true.
People are "hospitalized" at home, and there are many mysteries in "double-sided hospitals".
Li Lin reported that more than 200 people were fictitiously hospitalized in Zhengzhou Muzhou Hospital more than 400 times, and the local government verified 13 fictitious hospitalizations 38 times in 2022.
The reporter's recent investigation found that in addition to the local confirmed cases, there are also people who were "hospitalized" without knowing it, and were fabricated that their husbands had cancer, and the patients on many forged medical records were actually the mobile phone numbers of medical staff.
Death of a lover", "Endometrial carcinoma in situ", "Hypertension grade 3, very high-risk group", "1 baby boy and 1 baby girl who had natural delivery" ......Ms. Li, a 53-year-old native of Zhengzhou, has been hospitalized three times in Muzhou Hospital in Zhengzhou in recent years, but she retrieved 11 hospitalization records, and the fabricated situation on the fake medical records made her very angry. Ms. Li said in an interview with reporters: "I have never had cancer, I have no high blood pressure until now, my husband is living well, and now he works in an auto parts factory, I have 2 sons, and I have never given birth to a daughter." ”
The reporter flipped through Ms. Li's multiple cases and found that in the contact column of her hospitalized cases, her spouse was written as Guo Mou, whom she did not know, and the *** left by Guo happened to be the mobile phone number of Zhang, the head of the hospital's obstetrics and gynecology department. There are also 3 inpatient medical records, Ms. Li's *** was directly written as the mobile phone number of Zhang, the head of the hospital's obstetrics and gynecology department.
The reporter also obtained a number of forged medical records of another "hospitalized" patient surnamed Li, and on these fake inpatient medical records, the patient's *** left the mobile phone number of Zhang, the vice president of the hospital.
Li Lin told reporters that the mobile phone number of which medical staff was left in the patient's *** column on the fake medical record, which medical staff forged this medical record, and left his mobile phone number to facilitate the verification of the medical insurance regulatory department.
Zhengzhou Muzhou Hospital was founded in 1984, before the public Zhongmu County Second People's Hospital, and in 1998, it was reformed into a private hospital by the joint-stock system. At present, the hospital has more than 400 employees, is a designated hospital for medical insurance in Henan Province and Zhengzhou City, and was approved as a "second-class A" hospital by the Zhengzhou Municipal Health Commission in September 2022.
Although 25 years have passed since the shareholding reform, Zhengzhou Muzhou Hospital and its president, Yuan, have dual identities. The reporter's investigation learned that this private hospital currently also has a public institution legal person certificate. The certificate shows that the funds** are financial subsidies, and the organizer is the Zhongmu County Health Commission, which is valid from April 13, 2023 to April 13, 2024. Yuan has served as the president of this private hospital for more than 10 years, but she has always been a member of the public institution, retiring as the president of the Second People's Hospital of Zhongmu County in June 2020, and is still serving as the president of Zhengzhou Muzhou Hospital.
Mao Guangzhi, deputy secretary of the party group of the Zhongmu County Health Commission, said that Zhengzhou Muzhou Hospital is a private hospital, and the funds are self-raised, and there is no financial allocation, but there are still dozens of personnel in the hospital who are in public institutions, which is a problem left over from the shareholding system reform in that year.
Maintain a high-pressure posture of cracking down on fraud and insurance fraud, and strengthen supervision before and during the event
In response to the reported incident of Zhengzhou Muzhou Hospital, the local government has made an inspection and punishment conclusion in September 2022: it was found that the hospital had problems such as excessive standard charges, applied project charges, out-of-label medication, and repeated charges3 medical insurance physicians were suspended from medical insurance prescription for 3 months, and 7 medical insurance physicians were interviewed and remindedRecovery of non-compliant funds 614016308 yuan, and the hospital will be charged liquidated damages equal to 1 times of the illegal funds, totaling 12280326$16. In addition, the clues of suspected violations found in the investigation have been handed over to the public security organs, which filed a case in February this year.
Recently, the Zhengzhou Municipal Medical Security Bureau once again sent a special team to Zhongmu County to investigate and verify the situation, reviewed the relevant files of Zhengzhou Muzhou Hospital, and launched a concentrated action to verify the clues of the medical insurance problem in the city. The reporter recently learned from the Propaganda Department of the Zhongmu County Party Committee that President Yuan and others have arrived at the case.
Wang Fuquan, deputy director of the Zhengzhou Municipal Medical Security Bureau, said that the next step will be to continue to improve the level of medical insurance supervision capabilities, draw inferences from one case and do a good job in the city's clue verification work, innovate big data intelligent supervision methods, full coverage, no dead ends, zero tolerance, resolutely crack down on all kinds of fraud and insurance fraud, and make good use of medical insurance.
Ren Jianwei, a member of the party group of the Zhongmu County Medical Security Bureau and director of the medical insurance center, said that the incident in Zhengzhou Muzhou Hospital, on the one hand, reflects that there are serious loopholes in the internal control system of individual hospitals, self-control is not strict, and some hospital management personnel have poor self-discipline, weak awareness of medical insurance law and discipline, and there is a fluke mentalityOn the other hand, it also reflects that the medical insurance supervision is still incomplete and the supervision is not detailed, focusing on post-event supervision, and the pre-event supervision is not in place.
Industry insiders said that medical insurance is the people's "life-saving money", and it is necessary to find and severely punish the insurance fraud, so that the insurance fraudsters will pay a heavy price, maintain the high-pressure situation of cracking down on fraud and insurance fraud, and form a strong deterrent to those who are lucky. At the same time, it is necessary to enrich the regulatory team, strengthen the professional ability training of supervisors, encourage the use of new technologies to supervise, and continuously improve the efficiency of medical insurance supervision.
*丨Xinhua News Agency (the copyright belongs to the original author, if there is any infringement, please contact to delete).