1. Dehui Misa Wellcome Hospital violated regulations.
After investigation, Dehui Misa Wellcome Hospital has some problems, such as carrying out treatment projects beyond the scope of product use, over-medical insurance restricting drug use, using drugs without indications, unreasonable charges, and incorrect catalogue comparison. , involving medical insurance fund 650 1.600 yuan. According to the service agreement of designated medical institutions for medical security in dehui city in 2020, the local medical insurance department will make the following treatment: 1. Interview the main person in charge of the hospital and order rectification; 2. Recover the illegal use of medical insurance fund of 65,065,438 yuan +0.6 million yuan.
Second, nine Baohua rehabilitation hospitals violated regulations.
After investigation, Jiutai Baohua Rehabilitation Hospital has some problems, such as using exercise therapy beyond the scope and providing first-class care for patients who do not meet the first-class care indications, involving medical insurance fund of 470,438+00,000 yuan. According to Article 66 of the Medical Insurance Designated Medical Institutions 202 1 Medical Service Agreement in Jiutai District of Changchun City, the local medical insurance department made the following treatment: 1. Interview the president of the hospital and order immediate rectification; 2. Refusing to pay 470 1 10,000 yuan for illegal use of the medical insurance fund.
Third, Changchun Shuangyang Hongqiao Hospital violated regulations
After investigation, Changchun Shuangyang Hongqiao Hospital has problems of drug use beyond the scope of medical insurance catalogue and unreasonable charges, involving medical insurance fund of 448,800 yuan. According to the provisions of Articles 7, 23, 26 and 62 of the Medical Service Agreement of Medical Insurance Designated Medical Institutions in Changchun City in 2020, the local medical insurance department makes the following treatment: 1. Interview the president of the hospital and make rectification within a time limit; 2. Refusing to pay 448,800 yuan for illegal use of medical insurance fund.
Fourth, Changchun Hengshi Pharmaceutical Co., Ltd. violated the rules.
After investigation, Changchun Hengshi Pharmacy Co., Ltd. has the problem of providing medical insurance fee settlement for non-designated medical institutions or medical institutions during the suspension of medical insurance service agreement.
According to Article 43 of Changchun Medical Insurance Designated Retail Pharmacy Service Agreement (202 1) and Article 1 of Changchun Medical Insurance Designated Retail Pharmacy Assessment Rules (Provisional), the local medical insurance department made the following treatment: 1. Deduct the annual assessment score10; 2. Terminate the medical insurance service agreement.
Verb (abbreviation of verb) Lan Shu Huimin Hospital violated the rules.
After investigation, there are some problems in Lan Shu Huimin Hospital, such as low admission indications, over-standard fees, medical consumables inconsistent with actual sales, etc., involving medical insurance fund of 299,200 yuan. According to the provisions of Item (4) and Item (7) of Article 64 and Item (10) of Article 65 of the Service Agreement for Designated Medical Institutions of shulan city Medical Insurance in 2020, the local medical insurance department makes the following treatment: 1 Recover the illegal use of medical insurance fund of 299,200 yuan; 2. Interview the person in charge of the hospital and order rectification.
6. Six stores of Hongyu Pharmacy in Yongji County violated regulations.
After investigation, there is a problem that the uploaded medical insurance information is inconsistent with the actual sales of drugs sold in the sixth store of Hongyu Pharmacy in Yongji County, involving the medical insurance fund18.10.6 million yuan. According to Paragraph 2 of Article 48 of the Service Agreement of Designated Retail Drugstores for Urban Employees' Basic Medical Insurance in Yongji County in 2020, the local medical insurance department made the following treatment: 1 Recover the illegal use of medical insurance fund18.10.6 million yuan; 2. Suspension of medical insurance settlement for 3 months; 3. Interview the person in charge of the pharmacy and order rectification; 4 in the county designated medical institutions within the scope of notification.
7. Violation of Yannian Pharmacy in Changyi District, Jilin City
After investigation, there is a problem that the information uploaded by medical insurance does not match the actual sales in the sales of drugs in Yannian Pharmacy in Changyi District, Jilin City, involving a medical insurance fund of 220,400 yuan. According to Item (2) of Article 48 of Jilin Province Medical Insurance Designated Retail Pharmacy Service Agreement in 2020, the local medical insurance department made the following treatment: 1. Refusing to use the medical insurance fund in violation of regulations is 220,400 yuan; 2. Suspension of medical insurance settlement for 3 months; 3. Interview the person in charge of the pharmacy and order rectification.
Eight. Guo Dayi and pharmacy Jilin Co., Ltd. Yitong Shunfa Branch violated the rules.
After investigation, Guo Dayi and Yitong Shunfa Branch of Jilin Co., Ltd., a pharmacy, violated the rules of taking medical insurance funds by exchanging drugs, involving 55,600 yuan of medical insurance funds. The local medical insurance department made the following treatment according to the Service Agreement for Medical Institutions of Designated Drugstores of Basic Medical Insurance in Yitong Manchu Autonomous County in 2020: 1. Interview the main person in charge of the pharmacy and order rectification; 2. Suspension of medical insurance services for 3 months; 3. Recover the illegal use of medical insurance fund of 55,600 yuan.
Nine, Siping Chengxin Yonghong Pharmacy Chain Co., Ltd. Tiedong Branch violated the rules
After investigation, Tiedong Branch of Siping Chengxin Yonghong Pharmacy Chain Co., Ltd. has serious problems such as drug exchange. According to the relevant provisions of the 2020 Jilin Province Basic Medical Insurance Designated Pharmacy Service Agreement, the local medical insurance department made the following treatment: 1. Refusing to pay all the deposit and reserve fund of 882,300 yuan; 2. Refusing to pay 794,900 yuan for illegal use of medical insurance funds; 3. Recover the loss of medical insurance fund of RMB 6,543,800+0.47 million; 4 termination of medical insurance service agreement, shall not apply for medical insurance designated medical institutions within three years.
X. Violation case of Liaoyuan Huaying Hospital
After investigation, Huaying Hospital in Liaoyuan has some problems, such as low-standard hospitalization, over-quota drug use, over-standard drug retail price, untrue financial data and inconsistent accounts, involving medical insurance fund of 2,543,900 yuan. According to the relevant provisions of Article 65 and Article 67 of the Medical Service Agreement of Medical Insurance Designated Medical Institutions in Liaoyuan City in 2020, the local medical insurance department makes the following treatment: 1 Refused to illegally use the medical insurance fund of 2,543,900 yuan; 2. Suspend the hospital medical insurance service and hand over the case to the public security organ for handling. At present, the public security organ has filed a case and the case is under investigation.
XI。 Illegal case of Liaoyuan Xiangrui Geriatric Rehabilitation Hospital
After investigation, Liaoyuan Xiangrui Geriatric Rehabilitation Hospital has problems such as repeated drug use, repeated hospitalization and inconsistent drug accounts, involving medical insurance fund1053,600 yuan. According to Article 65 of the Medical Service Agreement of Medical Insurance Designated Medical Institutions in Liaoyuan City in 2020, the local medical insurance department made the following treatment: 1. Refuse to use the medical insurance fund in violation of regulations1053,600 yuan; 2. Suspension of medical insurance services for 3 months; 3. Deduct all the points of medical insurance doctors Liu, Guo Mouna and Hou Moya for the whole year, and suspend the qualification of medical insurance doctors 1 year.
Twelve. Liaoyuan Renai Hospital violated the rules
After investigation, there are some problems in Liaoyuan Renai Hospital, such as over-standard drug use, over-restricted drug use, drug retail price, incorrect corresponding diagnosis and treatment items, and inconsistent accounts, involving medical insurance fund 1.736, 5438+0.300 yuan. According to the provisions of Articles 64 and 65 of the Medical Service Agreement of Medical Insurance Designated Medical Institutions in Liaoyuan City in 2020, the local medical insurance department makes the following treatment: 1 Recover the illegal use of medical insurance fund 1.73 1.300 yuan; 2. Suspension of medical insurance services for 3 months; 3. Deduct all points of medical insurance doctors Liang Moli and Qin Mouying for the whole year, and suspend the qualification of medical insurance doctors 1 year.
Thirteen. Tonghua Shengjing Gastrointestinal Hospital violated the rules
After investigation, Tonghua Shengjing Gastrointestinal Hospital has some problems, such as low standard and hospitalization without indication, involving medical insurance fund of 30010.2 million yuan. The local medical insurance department made the following treatment according to Tonghua Medical Insurance Designated Medical Institutions 202 1 Service Agreement: 1. Ordering the hospital to immediately rectify the problems found in the inspection; 2. Recover the illegal use of medical insurance fund of 3,065,438 yuan +0.2 million yuan; 3. Suspend the medical insurance service of the hospital for 6 months; 4. Incorporate violations into the annual assessment.
Fourteen Ji 'an Asia-Pacific Hospital Violation Case
After investigation, there are some problems in Ji 'an Asia-Pacific Hospital, such as hanging bed hospitalization, low-indication hospitalization, over-medication, no-indication medication, repeated medication, overtreatment and over-examination, involving medical insurance fund of 6,543,800+0,574,000 yuan. The local medical insurance department shall handle the following matters according to the Service Agreement for Designated Medical Institutions of Ji 'an Basic Medical Insurance and the Administrative Measures for Medical Insurance Service Physicians in Designated Medical Institutions of Jilin Province: 1. Order rectification; 2. Recover the illegal use of medical insurance fund of RMB 6,543,800+0,574,000; 3. Suspend Liu Moupeng's qualification as a medical insurance physician, and deduct 3 points from the annual assessment scores of medical insurance physicians of Li Moufeng, Jin Moulu, Lu Mouhua and Pang Mou.
Fifteen. Violation case of Liuhe County Central Hospital
After investigation, there are some problems in Liuhe County Central Hospital, such as unreasonable charges, out-of-range drug use restriction, dispensing items, over-medical treatment, false charges, repeated charges and drugs without indications, involving 358,800 yuan of medical insurance fund. The local medical insurance department shall handle it according to the service agreement in the following ways: 1. Ordering rectification within a time limit; 2. Recover the illegal use of medical insurance fund of 358,800 yuan; 3. The annual assessment of 33 medical insurance doctors such as Pei and Zhang will be deducted by 2 points; 4. Incorporate the breach of contract into the annual assessment.
Sixteen, Jilin Baishan Hexing Health Pharmacy Chain Co., Ltd. Central Store and Sixth Store Violation Case
After investigation, it was found that there was a problem of dressing change in the central store and the sixth store of Baishan Hexing Health Pharmacy Chain Co., Ltd. in Jilin Province, and the two institutions involved in the medical insurance fund of 925,800 yuan. According to the service agreement, the local medical insurance department will handle it as follows: 1. Recover the illegal use of medical insurance fund of 925,800 yuan; 2. Cancel the service agreement of designated retail pharmacies.
Seventeen, baishan city Kangda Pharmacy Chain Co., Ltd. a shop violation case.
After investigation, the first store of baishan city Kangda Pharmacy Chain Co., Ltd. had the problem of dressing change, involving the medical insurance fund of 2 1.90 million yuan. According to the service agreement, the local medical insurance department will handle it as follows: 1. Recover the illegal use of medical insurance fund 2 1.90 million yuan; 2. Cancel the service agreement of designated retail pharmacies.
Eighteen, Changbai Korean Autonomous County Changbai Town Health Center violations.
After investigation, Changbai Town Health Center in Changbai Korean Autonomous County has some problems, such as over-range medication, over-standard charges, repeated medication, etc., involving 30,200 yuan of medical insurance fund. According to the service agreement, the local medical insurance department will handle it as follows: 1. Refusing to illegally use the medical insurance fund of 30,200 yuan; 2. Interview the person in charge of the hospital and order rectification within a time limit.
Nineteen. Ningjiang Xin Ying Hospital Violation Case
After investigation, Ningjiang Xin Ying Hospital has some problems, such as over-limit medication and low admission indications, involving medical insurance fund of 245,300 yuan. According to Articles 66 and 67 of the Service Agreement for Designated Medical Institutions of Songyuan Basic Medical Insurance in 2020, the local medical insurance department makes the following treatment: 1 Recover the illegal use of medical insurance fund of 245,300 yuan; 2. Suspension of medical insurance services for 2 months; 3. Rectification within a time limit. Because the hospital failed to return the illegal medical insurance fund to the fund account of Songyuan Social Medical Insurance Administration as scheduled, the local medical insurance department terminated the medical insurance service agreement of the hospital according to the service agreement, and was not allowed to apply for designated medical institutions for medical insurance within three years, and applied to the ningjiang district People's Court for compulsory execution.
20. Cigna Pharmacy Violation Case in Taipingchuan Town, Changling County
After investigation, there are some problems in Xinnuo Pharmacy in Taipingchuan Town, Changling County, such as no purchase and sale ledger and no sales system in the store. According to the provisions of Articles 14, 24 and 41 of "202 1 Songyuan Medical Insurance Designated Retail Pharmacy Service Agreement", the local medical insurance department made the following treatment: the medical insurance service agreement of designated retail pharmacies was terminated.
21. Aibo Hospital in Zhenlai County violated the rules.
After investigation, there are problems in drug use and diagnosis and treatment projects in Zhenlai Pok Oi Hospital, involving a medical insurance fund of 72,000 yuan. According to Article 83 of the Service Agreement of Medical Insurance Designated Medical Institutions in Zhenlai County in 2020, the local medical insurance department made the following treatment: 1. Interview the person in charge of the hospital and order it to rectify within a time limit; 2. Refusing to pay 72,000 yuan for illegal use of the medical insurance fund.
Twenty-two, the First People's Hospital of Da 'an City violated regulations.
After investigation, the First People's Hospital of Da 'an City has the problem of over-limit medication, involving the medical insurance fund of 75,300 yuan. According to Article 83 of the 2020 Da 'an Medical Insurance Designated Medical Institutions Service Agreement, the local medical insurance department makes the following treatment: 1. Ordering rectification within a time limit; 2. Refusing to pay 75,300 yuan for illegal use of medical insurance fund.
Twenty-three, Jilin Huaxi Pharmaceutical Chain Co., Ltd. Zhenxing Pharmacy Fourth Store Violation Case
After investigation, there were some problems in the fourth store of Zhenxing Pharmacy of Jilin Huaxi Pharmaceutical Chain Co., Ltd., such as the pharmacist was not on the job, some drugs were not clearly marked, medical insurance data was not uploaded as required, the purchase and sale accounts of drugs were inconsistent, and drugs were swapped, involving the medical insurance fund 1859.80 yuan. The local medical insurance department has handled the following matters according to Yanbian Medical Insurance Designated Retail Pharmacy Service Agreement (version 202 1): 1. Recover the illegal use of the medical insurance fund 1859.80 yuan and recover the liquidated damages of 557.94 yuan; 2. Terminate the medical insurance service agreement.
Twenty-four, Jilin Pharmacy Pharmaceutical Co., Ltd. Yanji Changbai Mountain Road Store violated the rules.
After investigation, Jilin Pharmacy Pharmaceutical Co., Ltd. Yanji Changbai Mountain Road Store has the problem of dressing change, involving the medical insurance fund of 444.70 yuan. The local medical insurance department made the following treatment according to Yanji Medical Insurance Designated Retail Pharmacy Service Agreement 202 1: 1. Recover the illegal use of the medical insurance fund of 444.70 yuan and recover the liquidated damages 133.4438+0 yuan; 2. Deduct the assessment score in the second half of 2026543811; 3. Terminate the medical insurance service agreement.
Twenty-five, Tumen City insured Fei Mouzhen violations.
After investigation, Fei Mouzhen (deceased), an insured person in Tumen City, has the problem of repeated insurance reimbursement, involving the medical insurance fund 5744+0 yuan. According to the social insurance law of People's Republic of China (PRC), the local medical insurance department has taken the following measures: recover the illegally used medical insurance fund +0 yuan 51988.99999919995. Because the children of the parties refused to return the illegally used medical insurance fund, the local medical insurance department filed a lawsuit with the local people's court. The local court ruled that the children of the parties concerned should return the illegally used medical insurance fund to the local medical insurance department +0 yuan 5998.1991916195 At present, the children of the parties concerned have fully returned the illegally reimbursed medical insurance fund to the expenditure account of Tumen Medical Insurance Fund.
Twenty-six, Meihekou Tianbao Neurology Hospital violated the rules.
After investigation, there are six problems in Meihekou Tianbao Neurology Hospital, such as broken hospitalization, over-limit medication, treatment times inconsistent with the cost list, psychotherapy time inconsistent with the price standard, the cost list inconsistent with the doctor's advice, no indications for electroacupuncture, and irregular medical record writing, involving the medical insurance fund of 23 1.4 million yuan. According to the relevant provisions in the first and third paragraphs of Article 60 in Chapter VII of the Service Agreement for Designated Medical Institutions of meihekou city Medical Security (202 1 Edition), the local medical insurance department has made the following treatment for the hospital: 1. Recover the illegal use of medical insurance fund of 23140,000 yuan; 2. Order the hospital to rectify immediately.