Baoding Medical Security Bureau comprehensively deepen the reform of the medical insurance system

On July 13, Baoding City held a press conference to inform the city's medical insurance reform for acceleration, quality service escorting the new face value, and answered the reporter's concern.

From June 1st to the end of June, 2022, the theme of "medical insurance policy and benefiting the people" is carried out throughout the city, with "entering institutions, entering the enterprise, entering the community, entering the countryside, entering the campus, and entering the hospital" as the main line. " Special operation of medical insurance policy "six -entry" propaganda. In order to do a good job of this propaganda activity, the Municipal Medical Security Bureau carried out a thorough arrangement and deployment. First, it was to improve political standing and resolutely implement decision -making and deployment at all levels. The second is to adhere to the people's supremacy and comprehensively improve the efficiency of medical insurance services. The third is to innovate and methods to ensure that medical insurance policies are deeply rooted in people's hearts. In addition, the WeChat public account of "Baoding Medical Insurance" has opened up the "Policy Propaganda Month" event column, and regularly publishes the progress of publicity work in various departments.

The Baoding Medical Security Bureau has continuously optimized medical insurance services, continued to improve the medical security system, and improved the medical insurance treatment steadily: realize the "no different places" in the province, actively promote the medical treatment of different places, and realize the online application identification of slow special diseases. Continue to improve the medical security system, and the medical insurance treatment has been steadily improved: the establishment of the basic medical insurance clinic system for urban and rural residents, and the improvement of the basic medical insurance clinic for urban employees, and continuously expand the scope of the physical species of the outpatient clinic (special), and steadily Improve the level of hospitalization treatment, and reduce the standards for hospitalization of urban employees and urban and rural residents. Always maintain a high -voltage trend of fund supervision, keep the people's "life -saving money": improve the construction of the regulatory system, carry out in -depth and publicity and publicity of medical insurance funds, and always insist on punching strikes. Continue to focus on key areas, and make every effort to fight against the reform of medical insurance reform: orderly promoting the purchase of centralized and band volume of drug consumables, effectively do a good job of rural revitalization connection, and comprehensively help the epidemic prevention and control.

The "Regulations on the Supervision and Administration of the Medical Security Fund" will be implemented from May 1, 2021. Among them, the "Regulations" stipulate that the illegal behavior of fixed -point pharmaceutical institutions is divided into general illegal acts and serious violations.

General illegal acts include:

(1) Decomposition hospitalization and hanging beds and hospitalization;

(2) In violation of diagnosis and treatment, excessive diagnosis and treatment, excessive examination, decomposition prescription, overcurrent prescription, repeated medicine or other unnecessary medical services;

(3) Repeat charging, over -standard charges, and decomposition project charges;

(4) String drugs, medical consumables, diagnosis and treatment items and service facilities;

(5) Provide convenience for insured persons to use their opportunities to enjoy medical security treatment, accept cash, physical or other illegal benefits;

(6) The medical expenses that do not belong to the payment scope of the medical security fund are included in the medical security fund settlement;

(7) Other illegal acts that cause the loss of medical security funds.

If a designated pharmaceutical institution has one of the above circumstances, the medical security administrative department shall order correction and can interview the relevant person in charge; if the loss of the medical security fund will be ordered, it shall be ordered to return, and the amount of the loss will be reduced by more than 2 times the amount of losses; refuses to refuse Those who do not correct or cause serious consequences shall be ordered to suspend the suspension of the relevant responsible departments of the relevant responsible departments for more than 1 year and less than 1 year. Those who violate other laws and administrative regulations shall be handled by the relevant authorities according to law.

Serious illegal acts include:

(1) inducing, assisting others with names or false medical treatment, purchasing medicines, providing false certification materials, or stringing to other people to open a fee document;

(2) Forgery, altering, concealment, altering, destruction of medical documents, medical certification, accounting vouchers, electronic information, etc.;

(3) Fictional pharmaceutical service projects;

(4) Other acts of cheating medical security fund expenditures.

If the fixed -point pharmaceutical institution deceives the expenditure of the medical security fund through the above methods, the medical security administrative department shall order the refund of the amount of more than 5 times the amount of less than 5 times or less; The pharmaceutical services used by the guarantee fund are terminated by the medical security agency to terminate the service agreement; if the qualifications are qualified, the relevant competent authorities will revoke the qualifications of practice in accordance with the law.

Director Yuan Yuci

Deputy Director Wang Mingyue

Written Cao Jia

Edit Liu He Tian

Review Jufeng

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