National Medical Insurance Bureau: Three years of inspection of fixed -point pharmaceutical institutions to recover 58.3 billion yuan in medical insurance funds

Cover news reporter Shao Meng

On July 22, the National Health and Health Commission held the 11th series of press conferences for the "All for the Health of the People -Our Ten Years" series, introducing the results of deepening medical reform work since the 18th National Congress of the Communist Party of China. The broader market of the Medical Insurance Fund is directly related to the problem of seeking medical treatment for the insured people. Li Shuchun, deputy director of the Medical Management Department of the State Medical Insurance Bureau, introduced that two measures were taken in terms of safeguarding the safety of the medical insurance fund.

Li Shuchun, deputy director of the Medical Management Department of the State Medical Insurance Bureau. Picture source: China Net

In terms of cracking down on fraud, Li Shuchun said that in the past four years, the State Medical Insurance Bureau has organized medical insurance departments at all levels to establish 5 mechanisms, including full -coverage daily supervision and inspection mechanisms, "dual random, one open" flight inspection mechanism, and more. The comprehensive supervision and joint disciplinary mechanism of the department, the reporting and reward mechanism for the whole people, and the public exposure mechanism, these five major mechanisms cooperated to combat, formed a joint supervision force, and also achieved unprecedented supervision results. The medical insurance agencies at all levels have strengthened the management of agreement management and daily review and settlement to ensure that the expenditure of medical insurance funds is more reasonable and standardized.

"From 2018 to 2021, through the special inspection of the supervision of the medical insurance fund and the daily inspection of the agencies, a total of 2.4 million fixed -point pharmaceutical institutions were inspected in the country, handling 1.15 million times, and recovering 58.3 billion yuan in medical insurance funds. "Li Shuchun also pointed out that as of the end of 2021, a total of 160 flights were launched, 336 designated pharmaceutical institutions were inspected, and more than 30 billion yuan of funds suspected of violations were found. The national and level medical insurance departments have established a reporting and reward system to open up report channels such as telephone, WeChat, and letters. The localities have been verified and recovered about 113 million yuan, and the report rewards were approximately 2 million yuan. In addition, the exposure has been strengthened. From 2019 to the present, there are 111 fraud cases exposed at the national level, and 140 million yuan of illegal funds involved.

In terms of establishing and improving the long -term supervision mechanism of medical insurance funds, Li Shuchun introduced that one is to explore and improve the supervision system of the medical insurance fund. The administrative departments of the four -level medical insurance of the state, provincial, municipalities, and counties have funding agencies and departments, established more than 150 full -time regulatory agencies, and established a regulatory team of more than 8,600 medical insurance funds.

The second is to strengthen the construction of the rule of law in the supervision of the medical insurance fund. The first administrative regulations in the field of medical security in my country, the regulations for supervision and management of the use of medical security funds. The implementation of the regulations provides a strong guarantee for the supervision of the medical insurance fund.

The third is to improve the institutional system of fund supervision. It has also promoted the introduction of the "Guiding Opinions of the General Office of the State Council on the reform of the medical security fund supervision system", and continuously improved six supervision systems of supervision and inspection, intelligent monitoring, reporting rewards, credit management, comprehensive supervision and social supervision, and further weaving medical insurance Fund regulatory cage.

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