At 10 a.m. on May 18, the State Council Information Office held a series of themed press conferences on "Comments from Authoritative Departments" to introduce the situation of "implementing the Party's 20th National Congress of Major Decisions and Deployments to promote the high-quality development of medical insurance", and A reporter asked.
Hu Jinglin, director of the National Medical Insurance Bureau, introduced that the medical insurance fund is the "life-saving money" of the people. The National Medical Insurance Bureau has thoroughly implemented the spirit of General Secretary Xi Jinping's important instructions, and has always taken strengthening the supervision of medical insurance funds and maintaining the safety of funds as our goal. The first task is to severely crack down on all kinds of illegal use of medical insurance funds, and never let the medical insurance fund become "monk meat". After 5 years of hard work, through the combination of "dots, lines and planes", a high-pressure situation in the supervision of medical insurance funds has been promoted.
First, the unannounced inspection passed the "acupoint-type" verification to achieve a "point breakthrough". Adopting the mechanism of "no advance notice, checking above and below, and cross-checking each other", effectively solved the problem of "same-level supervision in the society of acquaintances", and hit hard when violations of laws and regulations were found, and gave full play to the sword of "flying inspection" effect. At the same time, designated medical institutions are encouraged to draw inferences from one instance and conduct self-examination and self-correction, so as to avoid the recurrence of similar violations of laws and regulations. For medical institutions that take the initiative to conduct self-examination and self-correction, due consideration shall be given to aspects such as inspection frequency and penalty discretion, fully embodying the law enforcement concept of combining leniency with strictness. Since 2019, the National Medical Insurance Bureau has dispatched a total of 184 unannounced inspection teams, inspected 384 designated medical institutions, and found that 4.35 billion yuan of related funds were used in violation of laws and regulations.
Second, the special rectification realizes "online advancement" through "penetrating" inspections. The medical insurance department, in conjunction with the public security, health and other related departments, focuses on key areas such as orthopedics, hemodialysis, and cardiology, as well as key drug consumables, false medical treatment, and reselling medical insurance drugs, targeted supervision, and eliminates "life-saving money" that erodes the masses. Lesions". In 2022 alone, 2,682 cases were cracked, 7,261 suspects were arrested, and 1.07 billion medical insurance funds were recovered.
Third, daily supervision is empowered by data to realize "on the surface into a network". Make full use of modern information technologies such as intelligent monitoring and big data to accelerate the construction of an all-round, multi-level and three-dimensional supervision system. In 2022, 3.85 billion yuan will be recovered and recovered through intelligent monitoring, accounting for about 26% of the total recovered funds. With only a big data model of false hospitalization and precisely locked clues, nearly 500 people were arrested, and the amount involved in the investigation was nearly 100 million yuan.
In the next step, we will continue to increase the intensity of unannounced inspections, carry out in-depth special rectification against fraud and insurance fraud, seriously investigate and deal with a number of major cases, crack down on a number of major gangs, resolutely expose a number of prominent models, and consolidate the "dare not to cheat" "High pressure situation. Strengthen the supervision of big data, build a line of defense for the supervision of the whole society, weave a dense network of "do not cheat", improve the total fund budget, the retention of drug balances in centralized procurement and other policies, guide the two agencies and medical personnel to consciously standardize their service behaviors, and promote the establishment of "don't cheat" "Long-acting mechanism.
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