According to the contents of the report, Wuhan Medical Insurance Bureau conducted an investigation on the use and settlement of high-value orthopedic consumables medical insurance fund in tongji hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2065438+2007 10 to September 2020, and found that there was a problem of illegal settlement of consumables specification information in the orthopedics department of this hospital.
According to "Social Insurance Law" and "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds", Wuhan Medical Insurance Bureau made four administrative treatments on tongji hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology.
The hospital was ordered to suspend medical services involving the use of medical insurance funds for 8 months.
On April 20th, the official WeChat account of the National Medical Insurance Bureau announced the special flight inspection of tongji hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology notified by the National Medical Insurance Bureau.
After investigation, it was found that there were problems of exchange and false entry of high-value orthopedic medical consumables in tongji hospital during 20171-September 2020. At the same time, it was also found that other medical behaviors of tongji hospital 202 1 were suspected of using medical insurance funds in violation of regulations, which are still being further verified.
In the next step, Hubei Medical Insurance Bureau and Wuhan Medical Insurance Bureau should review and verify other problems found in flight inspection according to the division of responsibilities, and urge tongji hospital to seriously rectify; At the same time, effectively protect the rights and interests of the insured people, and orderly guide the insured patients to other hospitals for orthopedic treatment during the suspension of orthopedic medical insurance services in tongji hospital.
On April 19, tongji hospital issued "Handling of Loss of Medical Insurance Fund Caused by Incorrect and Illegal Settlement of Orthopedic Consumables Information", indicating that it fully accepted administrative punishment and resolutely rectified it.
Tongji hospital deeply reflected on the illegal use of medical insurance funds, organized special classes, actively cooperated with in-depth investigations, and resolutely made reforms. Tongji hospital will strictly follow the requirements of the National Medical Insurance Bureau and the provincial and municipal medical insurance bureaus, compact the main responsibility, comprehensively and thoroughly rectify, strengthen the accountability mechanism, seriously deal with those involved, and resolutely put an end to the recurrence of similar incidents.
The relevant person in charge of the National Medical Insurance Bureau said that the medical insurance fund is the "medical money" and "life-saving money" of the people. Any illegal use of medical insurance funds will harm the rights and interests of all insured persons, and the medical insurance department will seriously investigate and deal with it with a "zero tolerance" attitude. For the designated medical institutions involved, in accordance with relevant laws and regulations, not only administrative fines should be imposed, but also medical insurance service agreements should be suspended or even terminated; Involving illegal crimes or other related issues, but also to the judicial, discipline inspection and supervision, health and other departments to reflect. All designated medical institutions should take tongji hospital's illegal cases as a warning, establish a firm awareness of law-abiding, consciously regulate medical service behavior, provide reasonable and high-quality medical services for the insured, and earnestly fulfill the main responsibility of regulating the use of medical insurance funds.
legal ground
Article 7 of the Social Insurance Law of People's Republic of China (PRC) The payment period of retirees enjoying basic medical insurance benefits stipulated in Article 27 of the Social Insurance Law shall be implemented in accordance with local regulations.
Individuals who participate in the basic medical insurance for employees, when the relationship between basic medical insurance is transferred, the payment period of basic medical insurance is calculated cumulatively.
Article 8 The medical expenses incurred by the insured in the agreed medical institutions shall be paid by the basic medical insurance fund in accordance with the provisions of the state if they meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards.
If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.
Regulations on the supervision and administration of the use of medical insurance funds
Twentieth medical insurance agencies, designated medical institutions and other units and their staff and insured persons shall not forge, alter, conceal, tamper with or destroy medical documents, medical certificates, accounting vouchers, electronic information and other relevant materials, and shall not fabricate medical services to defraud medical insurance funds.
Twenty-first medical insurance funds are earmarked, and no organization or individual may occupy or misappropriate them.
Forty-fourth in violation of the provisions of this Ordinance, embezzlement, misappropriation of medical insurance funds, medical insurance and other administrative departments shall be ordered to recover; Illegal income, confiscate the illegal income; The directly responsible person in charge and other directly responsible personnel shall be punished according to law.
Could someone please give me a concise definition?