The official website of the Wuhu Medical Security Bureau of Anhui Province issued the "Circular on the Illegal Use of Medical Insurance ** by the Second People's Hospital of Wuhu City", the full text of which is as follows:
Report on the issue of illegal use of medical insurance by the Second People's Hospital of Wuhu City
On November 30, 2023, the online news about the Second People's Hospital of Wuhu City aroused social concern, and the Wuhu Municipal Party Committee attached great importance to it and established a joint investigation team headed by the person in charge of the city.
From March 19 to July 12, 2022, Yang Moumou was admitted to the Intensive Care Medicine Department of Wuhu Second People's Hospital for spontaneous cerebral hemorrhage, chronic renal failure (uremia stage), hypertension grade 3 (very high risk) and other diseases**. On July 12, 2022, he was transferred to the Second Affiliated Hospital of Wannan Medical College, and passed away on October 14, 2022.
On July 18, 2023, the Wuhu Municipal Medical Insurance Bureau received a petition report from the provincial bureau from Yang Moumou, 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**. Under the guidance of the Anhui Provincial Medical Insurance Bureau, on the basis of data screening and analysis, the Wuhu Municipal Medical Insurance Bureau and the Anhui Provincial Medical Insurance Bureau formed a provincial and municipal joint inspection team of more than 20 people on August 8 to enter the hospital to conduct a comprehensive verification of the hospital charges and medical insurance reimbursement during the hospitalization of the informant's father. 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, over-prescribing drugs, repeated charges, applied charges, and over-standard charges, involving the total cost of illegal medical treatment 21820,000 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 dealt with it according to the agreement: first, the full amount of the medical insurance used in violation of the regulations was recovered, and the penalty of 56,074 was deducted according to the 30% cap41 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. At the same time, the Wuhu Municipal Medical Insurance Bureau has initiated the administrative penalty procedure in accordance with the "Regulations on the Supervision and Administration of the Use of Medical Security". 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, 2023, and is currently being further verified. On September 25, 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 of Illegal Use of Medical Security", 5364 was given to the whistleblower04 yuan reward for reporting.
At present, the Second People's Hospital of Wuhu CityThe director of the department of critical care who has management responsibility has been given a warning sanction, and the director of the medical insurance office of the hospital who has supervision responsibility has been warned and adjusted。The Municipal Joint Investigation Team is further investigating and verifying the matters involved in the report, and will seriously deal with all verified issues in accordance with laws and regulations.
*: Official website of Wuhu Medical Security Bureau.