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Is the medical insurance reimbursement audit diagnosis true or false?
Is the medical insurance reimbursement audit diagnosis true or false?

Yes, the authenticity of the medical insurance reimbursement review diagnosis will be reviewed. In the process of medical insurance reimbursement, examination and diagnosis is an important part. The purpose of audit diagnosis is to ensure that the patient's condition and treatment conform to the medical insurance policy, so as to ensure the rational use and fair distribution of medical insurance funds. Therefore, the medical insurance department will review the authenticity of the audit diagnosis.

In order to ensure the authenticity of the audit diagnosis, the medical insurance department has taken various measures. First of all, the medical insurance department will supervise and investigate the diagnosis and treatment of the hospital to ensure that the hospital abides by the medical insurance policy and truly records the patient's condition and treatment. Secondly, the medical insurance department will also evaluate and review the doctor's treatment plan to ensure that the doctor's treatment plan conforms to the provisions of the medical insurance policy.

If the audit diagnosis is found to be untrue, the medical insurance department will take corresponding punishment measures, including suspending or canceling the qualification of hospital medical insurance reimbursement and imposing administrative punishment on doctors. At the same time, patients also need to bear corresponding legal responsibilities, including being recovered and reimbursed, and facing legal proceedings.

To sum up, the authenticity of medical insurance reimbursement audit diagnosis will be strictly examined, and hospitals and doctors must abide by the provisions of medical insurance policies to ensure the authenticity of medical records. At the same time, patients should also provide their own illness and treatment honestly and credibly to ensure the rational use and fair distribution of medical insurance funds.

Legal basis:

Article 87 of the Social Insurance Law of People's Republic of China (PRC) stipulates: "Social insurance agencies shall establish and improve business, financial, safety and risk management systems. The social insurance agency shall pay the insurance benefits in full and on time. "

The Regulations on the Supervision and Administration of the Use of Medical Security Funds stipulates: "The use of medical security funds shall conform to the scope and standards of payment stipulated by the state."