Since this year, the Fujian Provincial Bureau will "rectify the malicious fraud scam of the medical insurance, false condition, fake ticket" (referred to as "three fake"), standardize the use of medical insurance funds "to rectify the" topic rectification of the provincial discipline committee " The people around the people and the unfair wind selection, joint public security, health sector, heavy boxing combination, in-depth promotion of the special rectification of fraud scam of "three fakes", and continue to consolidate the high-pressure situation of medical insurance fund supervision.
As of the end of October, Fujian Province inspected 10,981 fixed-point medical institutions, including 271 medical insurance agreements, and lifted 32 medical insurance agreements, transferred to the judiciary, 6 of the discipline inspection and supervision, 517 people to handle illegal insurance A total of 30 million yuan; 31 cases of the "three fake" cases were investigated, and the amount of a million yuan was recovered. According to the Social Assessment, the National Bureau of Statistics shows that the masses have aware of the recognition rate of "three fake" special rectification work in the field of medical insurance regulatory in Fujian Province, satisfaction rate,% of support rates.
The evaluation results were higher than the overall evaluation of the "topic rectification" work (aware rate%, satisfaction rate%, support rate%), and a percentage point.
Establish multi-sectoral joint officers to deepen the fund supervision linkage mechanism, establish medical insurance, public security, Wei Jian joint work, vigorously promote departmental information sharing and interconnection, give full play to medical insurance, Wei Jian and other departmental expertise and public security organ investigation Advantage, forming supervision and cooperation.
Carry out the medical insurance data screening will formulate inspection rules with relevant departments. The extraction of medical services and medical expenses included in the scope of medical insurance payment in 2020, carry out data screening and data analysis, and the screening of suspected fraudulent parallel patriaries is transferred to all coordination areas.
Implementing daily inspection full coverage to formulate a list of unified on-site inspections in the province, clearly check the content. Further excavate the supervision function of the medical insurance service station and the implementation of the medical standard medical unit gridization supervision, and solidly promote the daily coverage task of medical insurance designated pharmaceutical institutions.
Fully promote the key inspection organization 10 special inspection groups, using the "Double Random One Open" way, from the top 30 fixed-point medical institutions in each co-ordination area, 36 medical institutions were drawn according to 12% ratio, And the corresponding 30 medical insurance agencies (previously checked excluded) as special governance key inspection objects.
27 medical institutions have been completed, 22 key inspections of 22 runners, and handle the problems clues to the local medical department for subsequent treatment.
Solidly carry out flight inspections for key reports, social influencing behaviors, social reflection hotspots, and large data analysis have a major doubt of pharmaceutical institutions, actively organize provincial flight inspections. The 4th flight inspection task has been completed in 2021.
The Fujian Medical Insurance Bureau will continue to strengthen the supervision of the medical insurance fund supervision, and resolutely safeguard the safety of medical insurance funds, optimistic about the "life-saving money"! (Editor: Chen Chuchu, Zhang Zijian) Sharing let more people see client download.