Anhui Provincial Medical Insurance Bureau and Wuhu City reported the results of the overcharging of medical fees by tertiary hospitals
Recently, the family of a patient in Wuhu City, Anhui Province reported that they were overcharged by the Second People's Hospital of Wuhu City, which caused widespread concern in the society. The reporter learned from the Anhui Provincial Medical Insurance Bureau and Wuhu City on the 3rd that after verification10 of the 15 issues involved in the report were basically true, involving the total cost of medical violations21820,000 yuan.
It is understood that in July this year, the Anhui Provincial Medical Insurance Bureau received a report from the masses, reflecting that the Second People's Hospital of Wuhu City used medical insurance in violation of laws and regulations during his father's hospitalization due to cerebral hemorrhage through fictitious and collusive exchange of diagnosis and treatment services. Subsequently, the bureau and the Wuhu Municipal Medical Insurance Bureau formed a provincial and municipal joint inspection team and stationed in the Wuhu Second People's Hospital to conduct a comprehensive verification of the hospital charges and medical insurance reimbursement during the informant's father's hospitalization. Through medical record verification, on-site inquiry, data comparison, etc., it was verified that 10 of the 15 problems involved in the report were basically true.
After investigation, the hospital had problems such as excessive diagnosis and treatment, excessive examination, and excessive prescription of drugs, involving a total of 21 illegal medical expenses820,000 yuan, of which 18700,000 yuan. In order to maintain the safety of medical insurance and protect the legitimate rights and interests of patients, according to the medical insurance service agreement signed between the hospital and the Wuhu medical insurance department, the Wuhu Municipal Medical Insurance Bureau first handled it according to the agreementThe first is to recover the full amount of the medical insurance ** used in violation of regulations, and deduct the penalty of 56,074 according to the 30% ceiling41 yuan;The second is to interview the relevant person in charge of the hospital and order him to immediately rectify the situationThird, they were handed over to the public security and health departments for further verification and handling. At present, all the above treatment measures have been completed.
Experts said that the medical insurance department generally has two ways to deal with the problem of illegal use of medical insurance by hospitals. One is the agreement processing, that is, the multiple treatment measures mentioned in the notice, which is characterized by rapid and timely, which is conducive to the medical insurance as soon as possible to stop the loss. The other is administrative punishment, which generally varies from 1 to 5 times the amount of medical insurance loss depending on the nature of the problem, which is characterized by strong punitiveness, but due to the need to perform procedures such as case filing, on-site inspection, complete collection of evidence, legal review, and notification before punishment, the timeliness of processing is low. According to the report of the Anhui Provincial Medical Insurance Bureau and the Wuhu Municipal Medical Insurance Bureau, the administrative punishment procedure for the Wuhu Second Hospital is ongoing.
While verifying the reported issues, the provincial and municipal joint inspection teams drew inferences from one case to another, and conducted a comprehensive extended inspection of the hospital's use of medical insurance** from April 1, 2022 to May 31 this year, which is currently being further verified, and will be seriously dealt with in accordance with procedures and laws and regulations in the future.
It is understood that in September this year, the Wuhu Municipal Medical Insurance Bureau gave written feedback to the whistleblower in the form of a regulatory notice in accordance with the "Implementation Rules for the Handling of Reporting Clues for the Supervision and Management of Medical Security in Anhui Province (Trial)". In accordance with the "Anhui Provincial Measures for Rewarding Whistleblowers for Illegal and Illegal Use of Medical Security", whistleblowers will be rewarded for reporting.
*:Xinhua.