Donggang District Medical Insurance Bureau started the "four battles" of the fund supervision

On July 11, the supervision of the Donggang District Medical Insurance Fund was selected as a grass -roots case by the Shandong Medical Security Bureau. In recent years, the supervision of the Donggang District Medical Insurance Fund has launched the "four battles" of the medical insurance fund supervision, and has established a full -chain, full system, and full -scale fund safety prevention and control system.

The "propaganda war" of the medical insurance law was launched to expand the policy coverage. Donggang District Medical Insurance Bureau made full use of modern media communication methods and tentacles, and in the ways of people's popularity, in -depth publicity and interpretation of medical insurance regulations and policies, and strengthening public opinion guidance and positive publicity. In April of each year, combined with the centralized publicity month of the Medical Insurance Fund to carry out the theme publicity activities of "Sunshine Medical Insurance · Love Wanjia", and issued a variety of promotional items, adopting awards, audio broadcasting, video collection selection, exposure typical cases, etc. Promoting the supervision of the medical insurance fund to the insured's main provisions and supervision and reporting channels, it has strongly created a social atmosphere of joint guardian funds. In 2021, the bureau won the Provincial Medical Insurance Bureau's "Regulations on the Supervision and Administration of Medical Insurance Fund" to publicize the Excellent Organization Award.

The "defense war" of the fund risk was launched, and the closed -loop protection chain was firmly. The Donggang District Medical Insurance Bureau strengthened the construction of the fund risk prevention and control mechanism, improved the internal management and supervision of the medical insurance agency, investigated the fund risk points throughout the process, formulated precise prevention and control measures, improved the ability to prevent and resolve risks; and implemented the supervision capacity of medical insurance funds. Utilize a variety of learning methods such as centralized learning, self -study, online school, and "going global" and "please come in" Refine disclosure of specific content, paths and methods, strengthen information analysis applications, and expand information disclosure of the scope of the risk of defense funds.

Stir off the "blocking war" of fraud and fraud, and polish the sword of supervision. For different ways to use the expenditure fund of different natures of different natures, Donggang District Classification formulates a audit plan. Regarding the use of designated pharmacies and ordinary clinics to supervise the use of "individual account funds", supervise the use of "overall funds" for designated hospitals and outpatient clinics; Carry out daily audit supervision; continue to carry out special rectification and "double random one open" inspection, focusing on combating the "three fakes" and the management of medical insurance funds in grass -roots medical and health institutions. Inspection and rectification with expenses; standardize the acceptance and investigation processing of complaint reports, and strictly follow the "Interim Measures for the Supervision and Management Report of the Medical Security Fund" and the relevant award regulations to do a good job of complaint report acceptance and handling rewards.

Since the establishment of the Bureau, it has recovered or refused to pay 1,855,54 million yuan in illegal funds, and administrative fines were 235,600 yuan. , Cash a reward of 200 yuan for 1 person.

Stir up the "joint war" in collaborative supervision and create a new ecology of the system. Donggang District formulated the "System of Coalition Conference on the Supervision of the Donggang District Medical Security Fund", and established and improved the coordination mechanism of membership units of joint conferences to form a new pattern of medical insurance fund supervision with close collaboration and grasp of common management; The credit -level management system of pharmaceutical institutions, explore the establishment of a medical insurance physician's credit management system, strengthen the differentiated supervision measures of trustworthiness incentives, and dishonest constraints. On the basis of hiring a group of people with a group of people with medical insurance policies and regulations and knowledge reserves and supervision enthusiasm to join the team of social supervisors to improve the depth and breadth of the supervisor's role. (Report on Yao Raiyao Correspondent of Rizhao Newspaper All Media Reporter)

- END -