Guard the "life-saving money" and officially launch! Covering the whole country, this inspection
In order to thoroughly implement the decisions and deployments of the Central Committee of the Communist Party of China and the State Council, crack down on illegal and irregular behaviors in the field of medical insurance, and resolutely abide by the people's "medical expenses" and "life-saving expenses", in accordance with the requirements of the "Notice of the National Medical Insurance Administration, Ministry of Finance, National Health Commission, and National Administration of Traditional Chinese Medicine on Carrying out the 2023 Medical Insurance Fund Flight Inspection Work", starting from August this year, the four departments will jointly organize medical insurance fund flight inspections covering 31 provinces and Xinjiang Production and Construction Corps in China.
The 2023 National Medical Insurance Fund flight inspection was officially launched in Bijie City, Guizhou Province yesterday. Flight inspections mainly focus on three aspects: designated medical institutions, retail pharmacies, and internal control management of medical insurance agencies.
The inspection of designated medical institutions includes the internal control management and financial management of medical insurance, the execution of centralized procurement with quantity based on drug consumption, the application of nationally unified medical insurance information business codes, and the medical service and fee behaviors involved in the use of medical insurance funds. Focus on three areas: medical imaging examination, clinical testing, and rehabilitation.
Yu Shanjun, Deputy Director of Jiangsu Provincial Medical Insurance Bureau, Leader of the National Medical Insurance Flight Inspection Team: During this hospital inspection, we mainly conducted data comparison, on-site medical record extraction, investigation of suspicious data, collection of relevant physical evidence, and communication with relevant personnel to better verify this issue.
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The inspection of retail pharmacies includes exchanging drugs or other goods that are not paid by the medical insurance fund for medical insurance drugs, falsely brushing or stealing medical insurance vouchers, forging or altering medical insurance drug purchase, sales, and inventory receipts and accounts, forging prescriptions or lists of insured personnel expenses, and settling medical insurance expenses for non designated retail pharmacies, designated retail pharmacies or other institutions during the termination of medical insurance agreements.
The inspection of internal control management of medical insurance agencies includes daily review, payment, and verification of fees declared by designated medical institutions and insured persons, determination of annual budget limits under DRG/DIP payment methods, and use of intelligent audit systems.