The year of work style 丨 Changping continues to purify the "ecological environment" of medical insurance, and be a good medical insurance fund "doorkeeper"!

This year, the Changping District Medical Insurance Bureau combined with the theme activities of the "Construction Year of the Style", closely focused on the safety of the medical insurance fund, set up a "first -leader" responsible work leading group, carried out special rectification work, continued to purify the "ecological environment" of medical insurance, and should be a good medical insurance. The fund "gatekeeper" provides a strong guarantee for the new situation of high -quality development of Changping's medical insurance industry.

Successfully complete the special governance work of the first phase of high -value consumables for the first phase of the medical institution

The Changping District Medical Insurance Bureau further strengthened the medical insurance fund closed -loop supervision and inspection model, and issued the supervision of high -value consumables in designated medical institutions in designated orthopedics surgery in the region, and then focused, deep inspections, and strict rectification. Multi -channel finding supervision and inspection entrances, through special inspection, dynamic monitoring of medical insurance databases, daily routine inspections, complaint reports, and hospital self -examination and self -correction, collect and organize effective clues, find breakthrough points, establish inspection ledger and violation processing platforms The accounts achieved the full coverage and the whole process, and the supervision and inspection work efficiently and accurately.

At the same time, strengthen the implementation of the implementation of the problem rectification, "look back" to prevent the problem of rectification and weakening the problem, and achieve normalization of supervision and inspection of pressure conduction. At present, the Changping District Medical Insurance Bureau has successfully completed the special treatment of the first phase of the first phase of the designated medical institution, and organizes the backbone for 10 designated medical institutions to conduct orthopedic surgery and have non -implantable high -value consumables in the region for on -site inspections. A total of more than 30,000 yuan for the medical insurance fund.

Special rectification work in key areas of medical insurance funds

The Changping District Medical Insurance Bureau and the Changping Branch of the Public Security Bureau and the Changping District Health and Health Commission and other departments have set up a special rectification joint working group to combat the "three fakes" (fake patients, fake illness, fake bills) illegal acts. In key areas, strengthen the supervision of the first -level and below designated medical institutions, strengthen the supervision of the medical institutions in the medical and nursing institutions, strictly investigate the results of genetic testing results, and strictly investigate the behavior of fraud medical insurance funds in the hemodialysis field.

"We comprehensively use agreements, administrative, judicial and other means, give play to the complementary role of departmental advantages, use joint performance and joint inspection model, strengthen information interoperability and case clues, and build the three links of 'medical, affected, and tube' with the same frequency resonance Comprehensive regulatory mechanism. "The relevant person in charge of the Changping District Medical Insurance Bureau said.

In addition, the Changping District Medical Insurance Bureau also focused on the use of main responsibilities of medical insurance funds in solid -point medical institutions to supervise them to carry out normalized self -examination and self -correction, strengthen self -management and active error correction capabilities, and promote self -standards and self -restraint. And actively introduce third -party forces, with the help of Human Insurance and Taikang Company, make full use of information and big data analysis methods to accurately carry out full coverage supervision and inspection to promote smart medical insurance supervision.

Actively create a conscious maintenance of the safe and strong social atmosphere of the medical insurance fund

The Changping District Medical Insurance Bureau took the first anniversary of the "Regulations on the Supervision and Administration of the Medical Security Fund" as an opportunity to carry out the promotion of the "Heating Fund Supervision Network Co -Building Medical Insurance Protection Line" publicity month and conduct centralized publicity. During this period, the designated propaganda columns (walls) and consultation desks of various fixed -point pharmaceutical institutions, and each social security institute took the initiative to enter the community (village) to effectively improve the conscious consciousness of safeguarding the safety of medical insurance funds.

At the same time, the Changping District Medical Insurance Bureau adopts a combination of traditional media and new media to expand publicity coverage in multiple forms of animation video, warning promotional videos, and exposure desks. Relying on the WeChat public account of "Changping Medical Insurance", create "Pingping" AI elves, and strive to create a "Pingping Medical Insurance" brand, launch the "Medical" minute "insurance" column, continue to consolidate the effectiveness of publicity, create "everyone knows everyone knows The law, everyone abide by the law "and the universal maintenance of the safety of the medical security fund.

It is understood that since the establishment of the Changping District Medical Insurance Bureau for three years, a total of 1,817 designated medical institutions have been inspected on -site; the refusal/recovery fee of 11.7146 million yuan is handled; 33 medical institutions and 35 are dealt with. Among them, one time was lifted, 4 interrupted execution agreements, 16 yellow ace warning, the city notified 8 critics, and the district notified 6 times. The regulatory work of the medical insurance fund in the district made breakthrough progress.

"When the crackdown of fraud and fraud is not completed, only when it is done, it will always be on the road." The relevant person in charge of the Changping District Medical Insurance Bureau said that in the face of the new situation and new tasks, the Changping District Medical Insurance Bureau will focus on accelerating the construction of the "Four Districts" to focus For focusing on tasks, continue to start with a micro -grasp in management, start with integrity and norms, comprehensively improve the supervision of the medical insurance fund with no restricted area, full coverage, and zero tolerance. "Standermen", protect the people's "seeing a doctor" and "life -saving money".

Photo/Wang Xingyue

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