Never let the medical insurance fund become the "meat of Tang Monk" (People's Current Review) system. Medical Insurance | Fund | Current Review
"Never let the medical insurance fund become the meat of Tang Monk!" Recently, at a press conference held by the State Council Information Office, Hu Jinglin, the director of the National Medical Security Administration, won praise from many netizens.
Medical insurance is a major institutional arrangement that reduces the burden of medical treatment on the public, enhances people's well-being, and maintains social harmony and stability. From 2018 to 2022, the annual total expenditure of the basic medical insurance fund increased from 1.78 trillion yuan to 2.46 trillion yuan, effectively playing a role in solving the concerns of the public about seeking medical treatment. It can be said that the medical insurance fund is related to the vital interests of every insured person and social stability, and its safe and stable operation is crucial.
As the regulatory authority of the medical insurance fund, the National Medical Insurance Administration has always regarded strengthening the supervision of the medical insurance fund and maintaining fund safety as its top priority. Over the past five years, it has dealt with 1.543 million illegal and irregular medical institutions, recovered 77.13 billion yuan of medical insurance funds, and exposed 245000 typical cases, demonstrating the determination and strength to take good care of the people's "medical expenses" and "life-saving expenses".
Guarding every penny of "life-saving money" is essential for institutional construction. In recent years, policy documents such as the "Regulations on the Supervision and Management of the Use of Medical Security Funds", "Interim Measures for the Management of Flight Inspections of Medical Security Funds", and "Implementation Opinions on Strengthening the Normalization of the Use of Medical Security Funds" have been successively issued, and some technical specifications have been implemented successively. The supervision of medical security funds has laws and regulations to follow.
Guarding every penny of "life-saving money" depends on the collaborative participation of various departments. In recent years, the National Medical Insurance Administration, in conjunction with the public security and health departments, has continued to carry out special rectification efforts, focusing on key areas such as orthopedics, hemodialysis, and cardiology, as well as key behaviors such as drug consumables, false medical treatment, and the resale of medical insurance drugs. Targeted supervision has been carried out to eliminate the "lesions" that erode the "life-saving money" of the masses. In 2022 alone, 2682 cases will be solved, 7261 suspect will be arrested, and 1.07 billion yuan of medical insurance fund will be recovered.
Guard every penny of "life-saving money" well, and demonstrate your skills in data empowerment. Fully utilize modern information technologies such as intelligent monitoring and big data to accelerate the establishment of a comprehensive, multi-level, and three-dimensional regulatory system. In 2022, intelligent monitoring was used to reject payments and recover 3.85 billion yuan, accounting for approximately 26% of the total recovered funds. Comprehensive measures, strict crackdowns on illegal activities, and strong supervision have effectively blocked "leaks" and ensured the safe operation of the medical insurance fund.
It should also be noted that even under regulatory pressure, the problem of non-standard use of funds still exists. Some designated medical institutions illegally use medical insurance funds through illegal charging, collusion of medical service projects, excessive diagnosis and treatment, and other means; Some even engage in malicious fraud and insurance fraud by fabricating medical service projects and other means. At the same time, situations such as "one person swiping a card, the whole family taking medicine", using fake cards, and one person holding multiple cards for scattered reimbursement occur in various regions. The illegal and irregular measures in the field of medical insurance are more covert and diverse. It is difficult to detect these fraudulent behaviors of "putting on invisibility clothes" solely through the unilateral power of the medical insurance department. It is necessary to effectively weave a network of fund supervision.
The medical insurance fund comes from the contributions and financial subsidies of insured individuals. In recent years, the basic medical insurance coverage rate in China has remained stable at around 95%. The encroachment on the medical insurance fund harms the interests of every insured person. From this perspective, it is not only the responsibility of the medical insurance department, but also the obligation of every insured person to effectively weave a network of fund supervision and firmly guard the bottom line of fund safety. It is necessary to build a supervision and defense line for the participation of the whole society, and continue to play an important role of social supervision in cracking down on illegal and irregular issues.
Intensify the inspection, crackdown, and exposure of illegal and irregular behaviors, and consolidate the high-pressure situation of "not daring to deceive"; Building a defense line for the supervision of the whole society and weaving a dense "cannot deceive" network of heaven and earth; Guiding medical insurance designated medical institutions, designated pharmacies, and medical staff to consciously regulate service behavior, promoting the construction of a long-term mechanism of "not wanting to deceive", can completely cut off the idea of illegal and irregular medical institutions and criminals exploiting loopholes, and enable every penny and every penny of medical insurance funds to be spent on treating diseases, saving people, and improving people's well-being.
