On the 13th, the National Medical Insurance Administration released the unannounced inspection of the 2022 annual medical insurance fund. In 2022, a total of 48 designated medical institutions in 23 provinces will be randomly inspected. Departments deal with designated medical institutions with problems in accordance with laws and regulations. Up to now, 720 million yuan of medical insurance funds have been recovered.
The 48 designated medical institutions randomly inspected by the national unannounced inspection team include 40 tertiary public hospitals, 3 tertiary private hospitals, and 5 private medical institutions below the second level. The medical institutions that were spot-checked mainly had repeated charges, over-standard charges, and charges for decomposed items; interchanging drugs, medical consumables, diagnosis and treatment items, and service facilities; including medical expenses that were not within the scope of payment of the medical insurance fund into the settlement of the medical insurance fund; excessive diagnosis and treatment in violation of medical norms , over-examination, over-prescription and other issues. In addition, some medical institutions have disaggregated hospitalization, inconsistencies between purchase, sale and inventory of medicines and medical consumables, failure to strictly implement the national organization’s centralized procurement policy for pharmaceutical consumables, and other violations of laws and regulations such as high patient group and low standard admission under the DRG payment model; Some medical institutions have the problem of fictitious medical service items.
In terms of rectification and implementation, up to now, 720 million yuan of medical insurance funds have been recovered, 120 million yuan of administrative fines have been imposed on 16 designated medical institutions, and 25.251 million yuan of liquidated damages have been imposed on 7 designated medical institutions. Further review is in progress. Each designated medical institution took the initiative to claim the problem, and took measures such as internal punishment of the responsible personnel, comprehensive cleanup of non-compliant and unreasonable diagnosis and treatment fee items, and optimization of the functions of the information system of the medical institution.
In 2022, 31 provinces carried out provincial-level unannounced inspections, inspected a total of 2,756 designated medical institutions, dealt with 2,413 designated medical institutions that violated laws and regulations, and recovered 1.98 billion yuan in medical insurance funds. The medical insurance departments in various places will deal with and punish them accordingly according to the severity of the problems found in the provincial fly inspection.
The relevant person in charge of the National Medical Insurance Bureau stated that, overall, the 2022 unannounced inspections will focus on large medical institutions in areas with rich medical resources, pointing out the typical problems of these institutions in the use of medical insurance funds, and urging designated medical institutions to be serious, comprehensive, and Solid rectification and reform have been made, and phased progress has been made in standardizing the use of funds in the medical insurance field.
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