Flight inspection of medical insurance fund refers to the on-site supervision and inspection by the administrative department of medical insurance on the use of medical insurance funds by medical insurance agencies, medical bidding and purchasing institutions, designated medical institutions, pharmaceutical enterprises, medical insurance physicians (pharmacists) and insured persons without prior notice.

Because the flight inspection is carried out without the knowledge of the inspected unit, it has the characteristics of not informing in advance, focusing on the attack, going straight to the scene, starting cautiously and acting quickly, so it can grasp the real situation in time and discover the actual situation of the inspected object.

The inspection mainly includes: medical service behavior and medical expenses in hemodialysis in designated medical institutions, high-value medical consumables (orthopedics, cardiology) included in the scope of medical insurance fund payment, the performance of service agreement of medical insurance agencies, and the audit and settlement of expenses. Severely crack down on defrauding medical insurance funds by forging medical-related materials and fictional medical service projects.

In addition, for designated medical institutions, this flight inspection will also focus on the internal management of fund use, financial management, related medical records management, purchase and sale of drugs and medical consumables and storage management, as well as the breakdown of hospitalization, hanging bed hospitalization, violation of diagnosis and treatment norms, illegal charges, exchange of goods, illegal purchase of offline drugs, illegal purchase and use of products selected by national organizations.

Implementation of flight inspection

There are five situations in which the administrative department of medical security can initiate the implementation of flight inspection, including:

(1) is arranged in the annual work plan.

(two) the clues to report complaints reflect that there may be major security risks in the medical security fund.

(3) Intelligent monitoring of medical security suggests that there may be significant security risks in the medical security fund.

(4) The exposure of news media has a great social impact.

(5) Other circumstances requiring flight inspection.

For the flight inspection arranged in the annual work plan, the administrative department of medical security shall organize the implementation in the form of "double random and one open". In addition, due to reporting complaints, intelligent monitoring, news media exposure, etc. , may cause significant financial security risks or have a significant social impact, as well as the need for confidentiality, you can directly carry out inspection work.