Take the lifesaving money into a sale

The hospital spent money to invite people to stay in hospital. “Patient” lived in a hospital and earned 200 yuan. Some people and institutions actually made a sale by defrauding “life-saving money” and “help money”. The reporter’s investigation found that the methods of defrauding medical insurance funds in some areas have been constantly refurbished, and practices such as fraudulent insurance, fraudulent claims, and misuse of medical insurance cards are madly eroding health insurance funds.

All kinds of chaos encroaching on medical insurance funds

Recently, some people have reported that the doctors of Changsha Wangchengpo Hospital are obliged to participate in the “hospitalization treatment” for elderly persons who are self-employed. They only need to provide a medical insurance card, and they can receive 200 yuan in reward after four days of hospitalization.

Many elderly grandfathers who were hospitalized in Wangchengpo Hospital told reporters that they seldom go to hospital during hospitalization, but they have a list of medication injections and checkups every day. Each hospitalization fee ranges from several thousand dollars.

Wang Haiwen, director of Changsha Wangchengpo hospital office, told reporters: “The department has a revenue-generating task. Liang Jianming, a physiotherapy department consultant recruiting in-patients in violation of the medical insurance policy in order to improve the performance of the department, has been investigated by the Medical Insurance Bureau. Actually, the physiotherapy department of the hospital has been suspended for rectification, and Dr Leung is facing punishment."

The reporter learned from the investigation that some hospitals in Changsha have paid people for hospitalization in order to apply for false hospitalization procedures for fake patients, and then took the false hospital settlement statement to the medical insurance department for reimbursement, and then they can take out the National Medical Insurance Fund.

In fact, it is no longer a novelty in the industry that bed-hanging fraud has become, and it has become a “hidden rule” for some hospitals to make profits illegally. It is understood that in 2013, 18 hospitals in Changsha had been investigated for irregularities such as the “surveillance of hospital beds” and the collection of medical insurance funds. These fraudulent insurance hospitals induced hospitalization frauds and defrauded medical insurance by means of “preferential” and “reporting”. fund.

Penalty is too light and repeated punishment

It is reported that most of these “cheat insurance” hospitals are private hospitals, and some “cheat insurance” hospitals have cases of “diagnosis and treatment of minor illnesses”. The minor illnesses that do not require hospitalization are changed to inpatient treatment when the inpatient medical records are filled out. Major illnesses, in order to obtain medical insurance funds. There are also some “counterfeit insurance” hospitals that have falsified false medical records, and spend money to hire insured patients to come to the hospital for hospitalization and falsely report drugs.

What is the consequence of the hospital being found to be hospitalized? A “industry source” told reporters that a hospital with serious violations of this type, the local medical insurance bureau gave a penalty of “stopping the medical insurance service qualification for one month and Corresponding fine."

Some basic medical insurance bureau staff told the reporter that the medical insurance supervision of the employees lacked legal policy basis, mainly based on the medical service agreement, leading the regulatory authorities to find that the hospital had “invited people to stay in hospital”, bed-hanging insurance, minor illnesses and major violations and other violations, and only one penalty. In addition, the penalties are mainly due to the suspension of hospital health insurance payment agreements. Due to the low cost of violations, many hospitals have repeatedly violated the penalty.

A staff member from the Medicare Bureau in the Central Province stated frankly: “The hospitalization of patients needs to meet the indications for hospitalization. The doctors can be admitted to the hospital for hospitalization indications. We do not understand these methods. We can only check whether the hospital’s per capita hospitalization fees are excessive or not. What medicines and what to check we do not understand, can not control."

According to a survey by the reporter, in addition to the fraudulent insurance, the change of the medical insurance card into a shopping card has become an open secret. In some pharmacies in Changsha, commodities such as daily necessities, food, and alcohol can be purchased through medical insurance card, and some products can also enjoy a 10% discount on medical insurance cards.

The reporter saw a pharmacy in Yuelu District, Changsha City, that non-pharmaceutical display counters displayed goods such as dried longan and cloud ear, and there were some different brands of wine at the bottom of the counter. The pharmacy staff told the reporter: “The dried squid has been sold out, and these products can be swiped with Medicare cards.”

Establish information sharing platform and improve supervision

Some grassroots medical insurance department staff told the reporter that the frauds currently being investigated and dealt with were inconsistent with hospitalization of hanging beds, minor illnesses, and major diseases. The punishment methods were mainly based on actual payments and inadequate supervision because of lack of supervision basis and relevant national laws and regulations. Not yet introduced, there are loopholes in laws and regulations that give lawbreakers an opportunity.

Lei Dongzhu, deputy director of the National People's Congress and the First People's Hospital of Luzhou City, believes that there are currently no unified plans and standards for medical insurance information in China. There is no common practice for information sharing across regions. Repeated insurance coverage and repeated reimbursement of fraudulent medical insurance funds are common occurrences.

Experts suggest that a medical institution information sharing platform be established to inquire about hospital ticket network enquiries and the time and place of inpatient visits, and record the use of medical insurance cards and rural cooperative cards in individual credit files, directly linked to the amount of reimbursement.

Lei Dongzhu believes that the supervision of medical insurance funds must be carried out by professionals who understand medical affairs and understand the finances, and supervise the hospital's medical practices and medical procedures. It is not possible to simply control the number of hospitalizations, hospitalization rates, and the average cost of hospitalization. Admission review, diagnosis and treatment procedures, drug proportions, and reimbursement for discharge are strictly monitored.