Repeatedly punished? Two county hospitals in Yunnan were fined 620,000 yuan and 300,000 yuan respectively for medical insurance violations
Two county people's hospitals in Yunnan were fined for violations such as switching medical treatment items and splitting items. On June 12, a reporter from Upstream News learned from the Credit China official website that on May 30 this year, the Luoping County People's Hospital in Qujing City, Yunnan Province and the Yongsheng County People's Hospital in Lijiang City were fined 620,000 yuan and 300,200 yuan respectively by the local medical insurance bureau for medical insurance violations.
Information about the punishment of Luoping County People's Hospital. Photo from Credit China's official website
The penalty information issued by the Luoping County Medical Insurance Bureau shows that due to charging without indicators, charging in reverse, and splitting charges, which violated medical clinical diagnosis and treatment standards and medical insurance-related policies, in accordance with Article 87 of the "Social Insurance Law of the People's Republic of China" and Article 38 of the "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds", the Medical Insurance Bureau imposed a fine of 6.22748 million yuan on the Luoping County People's Hospital.
On the same day, the Yongsheng County Medical Insurance Bureau of Lijiang also made a penalty decision on the illegal facts of Yongsheng County People's Hospital causing losses to the medical insurance fund. Information shows that due to five types of violations, such as charging above the standard, charging for alternate diagnosis and treatment items, charging for split items, excessive examinations, and repeated charges, the Yongsheng County Medical Insurance Bureau ordered Yongsheng County People's Hospital to immediately correct the illegal behavior in accordance with Article 38 of the "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds" and imposed an administrative penalty of a fine of 300,231.16 yuan, which was 1 times the amount of 300,231.16 yuan, for violating the law again and causing losses to the medical insurance fund.
Screenshot of the information about the punishment of Yongsheng County People's Hospital. Image from Credit China official website
Upstream News reporters noted that this is not the first time that Luoping County People's Hospital has been fined for medical insurance violations. In March 2020, the Yunnan Provincial Medical Security Bureau reported eight typical cases of combating fraud and insurance fraud. Among them, Luoping County People's Hospital was on the list for using the benefits of registered poor people to defraud medical insurance funds.
The notice shows that in 2019, Gao, a hospitalized patient, was taken back by his family after falling in Guangdong and was sent to the Department of Spinal Trauma Surgery of Luoping County People's Hospital for inpatient treatment. He did not participate in urban and rural residents' medical insurance, and used the household registration booklet and health poverty alleviation service certificate of Yin, a registered poor person in the village, to be hospitalized in his name. Because Luoping County People's Hospital did not strictly check the identity of patients seeking medical treatment, the medical insurance department deducted 68,200 yuan of illegal fees from Luoping County People's Hospital, and recovered 273,000 yuan in liquidated damages at 4 times the illegal fees. At the same time, Gao was ordered to return the 19,700 yuan of medical insurance funds that he defrauded.
In September 2023, the Luoping County Medical Security Bureau reported a case of medical insurance violations. The Luoping County People's Hospital used medical insurance funds in violation of regulations and was fined 758,500 yuan. From March 14 to March 23, 2023, the Luoping County Medical Security Bureau found in its daily supervision that the Luoping County People's Hospital had violated regulations in the use of medical insurance funds. Upon investigation, the hospital had violated regulations in the use of medical insurance funds by charging high fees, repeated fees, split fees, and fees for over-indications, involving an amount of 944,457.1 yuan.
In accordance with the Administrative Penalty Law of the People's Republic of China, the Social Insurance Law of the People's Republic of China, the Regulations on the Supervision and Administration of the Use of Medical Security Funds, and the Yunnan Province Medical Security Administrative Penalty Discretion Benchmark Rules, the Luoping County Medical Security Bureau ordered the Luoping County People's Hospital to seriously check and rectify the existing problems, return the medical insurance funds used in violation of regulations of 944,457.1 yuan, and impose a fine of 758,507.1 yuan. At present, the medical insurance funds used in violation of regulations of 944,457.1 yuan have been returned to the special account of the medical insurance fund, and the fine of 758,507.1 yuan has been paid to the state treasury.
After being fined, what corrective measures did Luoping County People's Hospital take? On the morning of the 12th, a reporter from Upstream News called Luoping County People's Hospital. The staff said that this issue would be answered by the county party committee's propaganda department, and "the hospital has nothing to say." The staff of the Industry Style Office of Yongsheng County People's Hospital said that they needed to report to the leadership before making a reply, but as of press time, the reporter had not received a response.
