Recently, the Anhui Provincial Medical Security Bureau issued a notice disclosing a case of illegal use of medical insurance ** by a hospital. According to the report, on July 18, 2023, Yang Moumou reported to the bureau that the Second People's Hospital of Wuhu City used medical insurance in violation of laws and regulations by fictitious, collusive exchange of diagnosis and treatment services during his father's hospitalization due to cerebral hemorrhage**.
In this regard, the Anhui Provincial Medical Security Bureau attaches great importance to it and takes swift action. On the basis of data screening and analysis, the bureau and the Wuhu Municipal Medical Insurance Bureau formed a provincial and municipal joint inspection team composed of more than 20 people on August 8, and stationed in the hospital for a comprehensive inspection. Through medical record verification, on-site questioning and data comparison, the verification team successfully verified that 10 of the 15 questions involved in the report were basically true.
After in-depth investigation and verification, the inspection team found that the hospital had a series of problems such as excessive diagnosis and treatment, excessive inspection, over-prescribing of drugs, repeated charges, applied charges, and over-standard charges. The total cost of non-compliant medical treatment in these cases is as high as 21820,000 yuan, of which the illegal use of medical insurance** is as high as 18700,000 yuan.
In order to maintain the safety of medical insurance and protect the legitimate rights and interests of patients, the Wuhu Municipal Medical Insurance Bureau has taken the following measures according to the medical insurance service agreement signed between the hospital and the Wuhu Municipal Medical Insurance Department
1.The full amount of the medical insurance used in violation of the law was recovered**;
2.According to the agreement, the maximum standard of 30% will deduct the penalty of 5607441 yuan;
3.The relevant person in charge of the hospital was interviewed and ordered to make immediate rectifications
4.The relevant issues were handed over to the public security and health departments for further verification and handling.
At present, all the above treatment measures have been successfully completed. At the same time, the Wuhu Municipal Medical Insurance Bureau has also initiated the administrative penalty procedure in accordance with the "Regulations on the Supervision and Administration of the Use of Medical Security". The occurrence and handling of this incident is of great significance for ensuring the safe and reasonable use of medical insurance, as well as promoting the standardized operation of hospitals and the protection of patients' rights and interests.
This incident once again reminds us that hospitals must comply with relevant laws and regulations when using medical insurance**, and cannot ignore the rights and interests of patients in pursuit of economic benefits. At the same time, the regulatory authorities should also strengthen supervision to ensure the safe and reasonable use of medical insurance. Only in this way can patients get better ** and service. Look for an AI Writer Program