Excessive diagnosis and treatment of medical insurance refers to the unnecessary examination, treatment or operation beyond the actual needs when medical institutions or doctors provide medical services, in order to increase medical insurance costs. This behavior violates the relevant provisions of medical insurance management, as follows:
1. Violation of the regulations on the use of medical insurance fund: medical insurance fund is a special fund to pay the medical expenses of insured persons, and excessive diagnosis and treatment will lead to unreasonable expenditure of medical insurance fund and waste of public resources.
2. Violation of medical norms and ethics: doctors should provide necessary medical services according to the actual situation and needs of patients, rather than conducting unnecessary examinations and treatments in order to increase income. Overdiagnosis and treatment violate medical norms and ethical principles.
3. Harm the interests of patients: Excessive diagnosis and treatment not only increases the economic burden of patients, but also may bring unnecessary pain and harm to patients.
Medical insurance overtreatment violates the relevant provisions of the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds and the Physician Law.
The Regulations on the Supervision and Administration of the Use of Medical Security Funds stipulates that medical institutions and their medical personnel shall not carry out unnecessary examination and treatment in violation of the norms of diagnosis and treatment. At the same time, medical institutions and their medical staff should implement the regulations on the management of medical treatment and drug purchase in real-name registration system, verify the medical insurance vouchers of the insured, provide reasonable and necessary medical services in accordance with the diagnosis and treatment norms, and truthfully issue expense documents and related materials to the insured.
The Physician Law also clearly stipulates that patients should not be overtreated. If the opinions of patients or their close relatives cannot be obtained due to emergency situations such as rescuing dying patients, corresponding medical measures can be implemented immediately with the approval of the person in charge of the medical institution or the authorized person in charge. In violation of the diagnosis and treatment norms, unnecessary examination and treatment are carried out, causing adverse consequences to patients. If the circumstances are serious, doctors will be ordered to suspend their practice activities for more than six months and less than one year until their practice certificates are revoked.
Therefore, the excessive diagnosis and treatment of medical insurance violates the above provisions, which not only wastes the medical insurance fund, but also harms the interests of patients.
To sum up, over-diagnosis and treatment of medical insurance violates the relevant provisions of medical insurance management, harms the interests of patients and wastes public resources, which should be severely cracked down and stopped.
Legal basis:
The Social Insurance Law of People's Republic of China (PRC) stipulates that medical institutions shall provide reasonable and necessary medical services for insured persons in accordance with relevant state regulations. Medical institutions shall not use medical insurance funds for unnecessary examination and treatment, and shall not engage in any form of fraud.
The Law of People's Republic of China (PRC) on Medical Practitioners stipulates that doctors should abide by professional ethics and medical norms, provide reasonable and necessary medical services for patients, and must not carry out unnecessary examination and treatment in violation of regulations.
The Anti-Unfair Competition Law of People's Republic of China (PRC) stipulates that medical institutions shall not obtain medical insurance funds by improper means, and shall not make false or misleading propaganda.
The above-mentioned laws and regulations provide a legal basis for cracking down on over-diagnosis and treatment of medical insurance.