In recent years, there have been many cases of insurance fraud and illegal use of medical insurance in the field. The following is a brief summary of some of the institutions in each province that have been **, all of which can be swiped up and down to read more:
Inner Mongolia Autonomous Region
Hulunbuir People's Hospital violated the diagnosis and treatment norms. There are violations of diagnosis and treatment norms in motor coordination training, bladder function training, freehand hand function training, limb balance function training, Bobas training, dysarthria, lumbar comprehensive exercise training, additional admission of critically ill patients, and deep anesthesia electrophysiological monitoring.
Hulunbuir Renai ** Hospital violated the diagnosis and treatment norms. There are cases of violation of diagnosis and treatment norms in the comprehensive training of body acupuncture and standing + walking ability.
A Rongqi People's Hospital violated the norms of diagnosis and treatment. Milliacupuncture, additional charges for critically ill patients, and limb compression** have violations of diagnosis and treatment norms.
Arong Banner Sino-Mongolian Hospital violated the norms of diagnosis and treatment. Anti-tumor chemotherapy drugs Non-centralized configuration of parenteral nutrition solution, intravenous injection with levocarnitine injection during hemodialysis patients**, three-dimensional dynamic interference electricity**, bladder function training, twelve-channel routine ECG bedside examination, dressing change (large), electroacupuncture, millineedle method, and intermediate frequency electrogram** There are violations of diagnosis and treatment standards.
Heilongjiang Province
Harbin Qicai** Hospital Discovery time: March 2023.
Violations: Hospitalization, over-the-limit, falsification of medical documents.
Amount of violation: 149,594964 yuan.
Harbin Medical Security Service Center handles:
Recovery of illegal medical insurance**, involving medical insurance for urban employees, subsidies for civil servants, medical insurance for urban and rural residents, and medical assistance**.
Transfer to the medical security administrative department at the same level.
Deduct the assessment points of the hospital and the physician.
Terminate the medical insurance service agreement.
Jixian Deyuan** Hospital Discovery time: May 2022.
Violation: Exceeding the medical insurance restriction and being included in the medical insurance settlement.
Amount of violation: 6,72792 yuan.
Jixian County Medical Insurance Bureau handles:
Order the violation to be corrected within a time limit.
Refusal to pay for medical insurance used in violation of regulations**.
Keshan County Jianyi Medical Care ** Hospital Discovery time: Dialysis special examination.
Violations: There is an issue of double charges.
Amount of violation: 16420,000 yuan.
Keshan County Medical Security Bureau handles:
The hospital was ordered to make corrections within a time limit.
Recovery of medical insurance for illegal use**, a fine of 16420,000 yuan.
Hebei Province
Tongrentang Zhongji (Shijiazhuang)** Hospital's violations: two fees were charged at the same time when carrying out "homework**" and "daily life action training".
Penalty time: August 23, 2023.
Shijiazhuang Qiaoxi District Medical Security Bureau handles:
Amount of fine: $175,521.
Violations of Shijiazhuang Ping'an Hospital: **Illegal settlement of medical security for some diagnosis and treatment items of the department**.
Illegal items and amounts:
Weight loss support system training" project: the amount of illegal payment is 14,202 yuan.
"Needle Bying**" item: unreasonable charge amount of 120,591 yuan.
Electronic Biofeedback**: Unreasonable charge amount of RMB 134,113.
The total amount of illegal settlement: 268,906 yuan.
Shijiazhuang Medical Security Bureau handles:
Recovery of medical benefits for illegal use**.
Amount of fine: $268,906.
Sichuan Province
Bazhong Hospital for the Disabled** Discovery time: July 2023.
Violations: over-price charges, excessive diagnosis and treatment, involving medical insurance ** expenditure 202$14.
Bazhong City Bazhou District Medical Security Bureau processing:
Order the hospital to return the medical insurance used in violation of laws and regulations**.
Administrative penalty, fine 202$14.
Interview the person in charge.
Yibin Kangning Psychiatric Hospital** Discovery time: July 2023.
Violations: excessive diagnosis and treatment, excessive standard charges, inconsistent purchase, sale and inventory, duplicate charges, involving illegal use of medical insurance**276,04300 yuan.
Yibin Nanxi District Medical Insurance Affairs Center handles:
The hospital was ordered to rectify within a time limit and recover 276,043 illegal fees00 yuan.
Pay a penalty of 15,00000 yuan.
Violations of Deyang Bone and Joint Hospital: Diagnosis and treatment items are wrongly matched and over-standard charges, involving the illegal use of medical insurance**0140,000 yuan.
Deyang Medical Security Affairs Center handles:
Order the hospital to rectify within a time limit and interview the main person in charge.
Recovery of medical insurance used in violation of regulations**0140,000 yuan, liquidated damages 0280,000 yuan.
Jianyang Jiale Spiritual ** Hospital's violations: non-standard medication, unreasonable inspection, involving illegal settlement of medical insurance**19144 yuan.
The medical insurance department handles: 19144 yuan, penalty 1006$4.
Meishan ** Hospital violations: charging unreasonable fees.
The medical insurance department handles: 7730 violations are recovered49 yuan, liquidated damages 200997 yuan, ordered to rectify within a time limit, and interviewed the person in charge of the unit.
Violations of Shengtai ** Hospital in Panzhihua City: over-recording and false expenses.
The medical insurance affairs center will deal with it: recover 20 yuan of illegal fees, pay 20 yuan of liquidated damages, order rectification within a time limit, and include it in the annual assessment and deduction of points.
Violations of ** Hospital in Jiang'an County: The management of drug purchase, sale and inventory is not standardized.
The medical insurance department will deal with it: order the hospital to rectify within a time limit.
Chengdu Qingbaijiang District Xinpeng ** Hospital violations: the settlement list is inconsistent with the actual use, and the charges are applied.
The medical insurance department handles:
Rectify within a time limit and interview the person in charge of the hospital.
The amount of the violation was recovered 179920 yuan, deducting the margin of 3598$40.
Hunan Province
Xiangya Hospital of Central South University, Hunan Provincial ** Hospital, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine: **Physiotherapy Department uses medical insurance in violation of laws and regulations, resulting in a loss of medical insurance payment of 98395372 yuan.
Amount of fine: 98395372 yuan.
Changsha Kangning** Hospital's violations: illegal use of medical insurance**, there are three categories of violations.
Liuyang Municipal Medical Security Bureau handled: ordered the hospital to return the loss**.
Amount of fine: 2 times ** loss, total 26,13708 yuan.
Violations of Changsha CNNC** Hospital: Failure to complete the necessary registration of secondary diagnosis and treatment subjects, and carry out X-ray and CT diagnosis and treatment activities.
Penalty result: warning and a fine of 1,000 yuan.
Anhua County Shengshi ** Hospital violations: physiotherapy fees, bed hanging, nursing and outpatient fees and other violations.
Penalty result: ordered the hospital to return the illegal amount of 171,95329 yuan.
The amount after verification is 49291$39 for a 4-fold fine, totaling $197,165$6.
Termination of the hospital service agreement.
Violations of ** Hospital, Hecheng District, Huaihua City: Excessive price charges, over-recording expenses, false expenses, collusion of diagnosis and treatment items, etc., involving an illegal amount of 21,066 yuan.
Penalty result: RMB 21,066 was recovered.
Penalty amount: 2 times the amount of the violation, totaling $42,132.
Order immediate rectification in place.
Violations of ** Hospital in Xiangyin County: decompose project charges, duplicate charges, excessive diagnosis and treatment and other issues.
Penalty result: ordered to return nearly 500,000 yuan of illegal funds, and imposed an additional fine of 1 times, and at the same time ordered to immediately rectify and interview the main person in charge of the hospital.
Henan Province
Wuyang Spiritual ** Hospital violations: medical insurance violations such as excessive standard charges and excessive inspections.
Penalty result: ordered the hospital to return the non-compliant medical insurance**68,896$1.
A fine of 68,896 was imposed1 yuan (1 times the violation**).
Xinxiang Disabled Persons' Federation** Hospital's violations: exceeding the standard charges.
The medical insurance department will deal with it: order the hospital to return the lost medical insurance**.
A fine (1 times the violation**) is imposed, the exact amount is not mentioned.
Pu Sunshine Da** Medical Center violations: Illegal charges.
The medical insurance department will deal with it: order the hospital to return the lost medical insurance**.
An administrative fine of 102,080 was imposed38 yuan.
Fujian Province
Violations of ** Hospital Affiliated to Fujian University of Traditional Chinese Medicine: Charging fees in violation of the relevant regulations of national, provincial and municipal drugs, medical consumables and medical service projects.
Handling by the medical insurance department: rectification within a time limit.
Recovery of 120,963 non-compliance fees56 yuan.
Violations of Zhao'an Anding** Hospital: The project of carrying out the Chinese medicine ** project of the diaphragm moxibustion method is beyond the scope of designated services of medical insurance, and the EEG biofeedback ** instrument is still in use beyond the effective use period.
The medical insurance department will deal with the recovery of unreasonable expenses for the non-compliant items.
Interview the main person in charge.
The use of instruments and equipment involved was transferred to the Zhao'an County Market Supervision Bureau.
Jilin Province
Violations of Songyuan North ** Hospital: over-standard charges, off-label diagnosis and treatment.
Handling by the medical insurance department: recovery of illegal use of medical insurance**16700,000 yuan, ordered to rectify within a time limit.
Qian'an County People's Hospital's violations: ** Department violated the use of isokinetic muscle strength training and guided education and training.
Involving medical insurance**: 40190,000 yuan.
Handling by the medical insurance department: recovery of illegal use of medical insurance**40190,000 yuan, ordered to rectify within a time limit.
Violations of Qian'an County Hospital of Traditional Chinese Medicine: ** Department violated the use of isokinetic muscle strength training and guided education and training.
Involving medical insurance**:3140,000 yuan.
Handling by the medical insurance department: recovery of illegal use of medical insurance**3140,000 yuan, ordered to rectify within a time limit.
Violations of Liuhe Renze Traditional Chinese Medicine Orthopedic Injury Hospital: inconsistent medical records, doctor's orders, and expense lists; Medication beyond the restricted range; Violation of the regulations on bringing medication to the hospital; The over-limit price part of the Eisai project is included in the medical insurance settlement.
Amount of violation involved: 3540,000 yuan.
The medical insurance department will deal with the above-mentioned violations immediately.
Recovery of medical insurance used in violation of regulations**3540,000 yuan, pay liquidated damages 1060,000 yuan.
Points will be deducted from the relevant medical insurance doctors.
Ningjiang Aixin Psychiatric ** Hospital's violations: Incomplete records of psychiatric monitoring scales.
Involving medical insurance**: 4680,000 yuan.
Handling by the medical insurance department: recovery of illegal use of medical insurance**4680,000 yuan, ordered to rectify within a time limit.
Shanxi Province
Pingyao Ren'an Psychiatric Hospital** violations: illegal use of medical insurance by over-range payment methods**.
Involved in medical insurance**: 121810$6.
The medical insurance department will deal with it: order rectification within a time limit.
Recovery of medical insurance**121810$6.
Liquidated damages 182715$9.
Violations of Taiyuan Delan ** Nursing Home: Hospitalization with a bed, violation of the standard charges of the project, over-scope practice, inconsistent signature font of the Chinese medicine ** physician, inconsistency between the patient's inpatient medical record and the record of the diagnosis and treatment manual, suspected of fictitious medical services, fictitious medical document fraud and medical insurance ** and other violations.
Involving the use of medical insurance in violation of rules and regulations**: 5001$3.
The medical insurance department handles:
Recover the medical insurance** used in violation of the regulations, and deduct the corresponding liquidated damages.
The hospital's medical insurance services were suspended for 6 months.
Leads on violations of laws and regulations involving the health department are to be promptly transferred to the health department for handling.
Clues on suspected fictitious medical services and fictitious medical documents to defraud medical insurance ** were transferred to the public security organs for further investigation.
Recovery of medical insurance **50013 yuan, 5 times the liquidated damages 25006The $5 has been handed over in full.
Violations in Datong Weidu Nursing Home: Violations of inducing and organizing insured persons to be hospitalized.
Involving the use of medical insurance in violation of rules and regulations**: 1090643 yuan.
The medical insurance department handles:
Recover the medical insurance** used in violation of the regulations, and deduct the corresponding liquidated damages.
Terminate the service agreement and refuse to accept the application of the designated unit of medical insurance within three years.
Recovery of medical insurance**1090643 yuan, liquidated damages 36695The 29 yuan has been handed over in full.
Violations of the Zuoquan **Hospital: Illegal use of medical insurance by means of collusion project charges, excessive inspections, illegal charges, and over-limit medication**.
Involving medical insurance**: 10708124 yuan.
The medical insurance department handles: recover the medical insurance **10708124 yuan.
A penalty of 2 times the penalty 21416248 yuan.
Anhui Province
Violations of She County Pinghe Psychiatric Hospital: Violations such as false expenses.
Involving the use of medical insurance in violation of rules and regulations**: 11535005 yuan.
The medical insurance department will deal with it: recover the medical insurance **115350 that is used in violation of regulations05 yuan.
Administrative fine 461,400$20.
Order immediate rectification.
Transfer unqualified personnel to carry out diagnosis and other problems to the county health commission.
Violations of Xuancheng Tianjian ** Specialized Hospital: unsound financial system, non-standard medical documents, excessive inspection, excessive diagnosis and treatment, collusion of diagnosis and treatment items, duplicate charges and the use of restricted drugs beyond the limited payment scope of medical insurance.
Involving the use of medical insurance in violation of rules and regulations**: 19894555 yuan.
The medical insurance department handles:
Recovery of medical insurance non-compliance costs 19894555 yuan.
Fines 260658$82.
Order rectification within a time limit.
The violations were handed over to the Xuanzhou District Health Commission.
Jiangsu Province
Wuxi Guoji ** Hospital Discovery time: the first quarter of 2023.
Violation: Unreasonable** situation.
Involving the use of medical insurance in violation of rules and regulations**: 3,880 yuan.
Medical Insurance Center Processing: Recover 3,880 yuan of illegal fees.
Liquidated damages of 3,880 yuan.
Xuzhou Zhongyuan ** Hospital Discovery time: December 2022.
Violations: Violations such as the use of restricted medications, violation of the three catalogue fees, failure to record medical records in detail, and collusion of items.
Involving the use of medical insurance in violation of rules and regulations**: 1591825 yuan.
Handling by the medical insurance department: 4 points will be deducted from the annual assessment.
Recovery of violation fees 1591825 yuan.
4775 liquidated damages48 yuan.
Violations of Xuzhou Renbo ** Hospital: Inducing and providing excessive medical services, using medical insurance** to pay for expenses outside the scope of medical insurance policies, violating the charging standards of the three medical insurance catalogs, and patients not meeting the admission standards.
Involving the use of medical insurance in violation of rules and regulations**: 12569974 yuan.
Handling by the medical insurance department: 4 points will be deducted from the annual assessment.
Recovery of non-compliance fees 12569974 yuan.
Penalty 3770992 yuan.
Nanjing Jinkang Geriatric Hospital's violations: using a variety of illegal means to obtain medical insurance**, including raising the patient's monthly hospitalization** to the maximum amount of medical insurance funds, falsifying medical records, prescribing drugs, forging test sheets, and providing medical insurance settlement to units without medical insurance qualifications.
Jiangyin Bo Yijia ** Hospital Discovery time: the first quarter of 2023.
Violations: unreasonable examination, unreasonable medication, unreasonable **, unreasonable charges, unreasonable hospitalization and other violations.
Involving the use of medical insurance in violation of rules and regulations**: 5317283 yuan.
Medical Insurance Center Processing: Recovery of Violation Fees 5317283 yuan.
ordered to pay double the liquidated damages of 53,17283 yuan, a total of 10634566 yuan.
Yixing Jiurucheng ** Hospital violations: excessive standard charges, non-standard ** and other problems.
Involving the use of medical insurance in violation of rules and regulations**: 160165$22.
The medical insurance center handles: recover the illegal fees and order the payment of liquidated damages, a total of 160165$22.
Deduct the annual assessment points.
Guangdong Province
Shanwei ** Hospital's violations: repeated charges (joint loosening training, balance function training).
The medical insurance bureau handles: about 1470,000 yuan.
Zhuhai Baiyun ** Hospital violations: irregularities such as irregular charges, no ** records or ** records are unknown.
Involving the use of medical insurance in violation of rules and regulations**: 4360,000 yuan.
Medical insurance center processing: recovery**4360,000 yuan.
Violations of ** Hospital in Wuchuan City, Zhanjiang City: Fictitious medical service items, bed hanging, repeated charges, collusion of diagnosis and treatment items and other violations.
Involving the use of medical insurance in violation of rules and regulations**: 85370,000 yuan.
Guangdong Provincial Medical Insurance Bureau: ordered to return the medical insurance settled in violation of regulations**85370,000 yuan.
A fine of 68 was imposed610,000 yuan.
Lufeng Causeway Lake Psychiatric ** Hospital's violations: Beds in ordinary wards exceed the standard charges.
Involving the use of medical insurance in violation of rules and regulations**: 112576$10.
Violations of Yihe** Hospital in Dongyuan County, Heyuan City: low standard admission, high set of scores, and off-label physiotherapy.
The above questions relate to health insurance**:278591$7.
Local medical insurance department processing: recovery of lost medical insurance**.
An administrative fine shall be imposed in accordance with the law.
Suspend the medical insurance service agreement of the hospital's ** department for three months.
Administrative fines 564579$92 has been paid in full.
Jiangxi Province
Yichun ** Hospital violations: Violations such as payment beyond the scope of medical insurance involve illegal and breach of contract use of medical insurance**: 42,843 yuan Handling measures: Yuanzhou District Medical Security Bureau recovered 42,843 yuan of illegal medical insurance**42,843 yuan and ordered rectification within a time limit.
Shandong Province
Violations of ** Hospital, Decheng District, Dezhou City: Exceeding the medical insurance payment limit for the use of drugs, exceeding standard charges, colluding diagnosis and treatment items, and other exceeding standard charges involve illegal amounts: 11842513 yuan (including 39,060 yuan for the exchange of projects) Handling measures: interview the person in charge of the hospital, instruct the hospital to immediately rectify the violations, and recover the 118425 of the violations13 yuan, and the administrative penalty is 78,120 yuan.
Hainan Province
Violations of medical clinics for the disabled in Danzhou City, Hainan Province: It was found that the illegal use of medical insurance ** behaviors such as exceeding the medical insurance restriction medication, exceeding the standard charges, and financial problems were found. Involving illegal settlement of medical insurance**176,332$16. Result: 176,332 violation fees were recovered16 yuan, the main person in charge of the clinic was interviewed and ordered to carry out comprehensive rectification.
Yunnan Province
Violation of Pu'er Kangbei ** Hospital in Yunnan Province: It was found that there were inpatients admitted to over-approved beds, and ** paid 107,757970 yuan. There was a violation of the discharge medication**, involving an amount of 70,28750 yuan. The total cost of non-compliance as a result of other issues was 1,147,867$20. Result: Processed in accordance with relevant laws and regulations, and recovered 1,147,867 violation fees$20. It is ordered to rectify within a time limit, and after the rectification period expires, the Pu'er Municipal Medical Insurance Bureau will organize acceptance. If there is anything missing, welcome to add it in the comment area!
endยท Welcome to like, watch, and share to the circle of friends**: The comprehensive and Kangzhi of various medical insurance bureaus This article is a comprehensive manuscript of "Kangzhi".