Full details have been announced, and a large number of designated medical institutions will usher in unannounced medical insurance inspections Source: Photo Network Source | Cyber Blue Author | Color Recently, the website of the Central Commission for Discipline Inspection and the National Supervisory Commission has intensively published articles about problems found in medical insurance unannounced inspections, involving medical insurance payment restrictions, excessive inspections, and duplication Charges, excessive charges, etc. According to the People's Daily, the medical insurance information platform has been launched in 31 provinces and Xinjiang Production and Construction Corps , effectively covering approximately 400,000 designated medical institutions. The "Announcement on the Unannounced Inspection of Medical Insurance Funds by the National Medical Security Administration in 2021" shows that in 2021, the National Medical Insurance Bureau will jointly the National Health Commission and the State Administration of Traditional Chinese Medicine Unannounced inspections were carried out on the use of medical insurance funds in 68 designated medical institutions ( 229 tertiary hospitals, 215 secondary hospitals, first level hospitals, 222 medical and nursing institutions) in 29 provinces across the country. According to the public announcement on the "Measures for the Management of Unannounced Inspections of Medical Security Funds (Draft for Comments)", the unannounced inspection of medical security funds refers to the inspection of designated medical institutions organized and implemented by the national and provincial medical security administrative departments. , medical insurance agencies, other institutions undertaking medical insurance business and other on-site supervision and inspections where the inspected objects are not notified in advance. 
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A large number of designated medical institutions from the top level to the county level will conduct medical insurance unannounced inspections
Specifically, on August 29, the Central Commission for Discipline Inspection and the National Supervisory Commission published an article "Medical insurance unannounced inspections found exceeding medical insurance payment limits, excessive inspections, and repeated charges to collectively "check the pulse" to find problems." On the evening of August 26, Yunnan Province The conference room of the Second Affiliated Hospital of Kunming Medical University was brightly lit, and representatives of the National Flying Inspection Team reported the problems in the inspection one by one.
The Second Affiliated Hospital of Kunming Medical University in Yunnan Province is a tertiary hospital. Xu Yucai, a medical reform expert, told Saibolan that the use of medical insurance funds is mainly in public hospitals. Starting from a tertiary hospital, the problems it generates are more representative.
"The Central Commission for Discipline Inspection issued intensive documents mainly because the irregular behavior of these medical institutions has seriously endangered the interests of patients. At the same time, after the implementation of the Supervision Law of the People's Republic of China , medical personnel were included in the The scope of national supervision will inevitably be monitored. "
There is no doubt that the national unannounced inspection team is not alone in conducting unannounced inspections of major tertiary hospitals, and the scope of unannounced inspections has also been extended from major tertiary hospitals to county level hospitals.
The "Announcement on the Unannounced Inspection of Medical Insurance Funds in 2021" shows that the National Medical Insurance Administration directly imposed administrative penalties on the Duchang County People's Hospital of Jiujiang City, Jiangxi Province for illegal use of medical insurance funds. According to its official website, the hospital’s psychiatry department ranks among the best in the country among hospitals of the same level.
The National Medical Insurance Administration has clarified in the "2022 Medical Security Fund Unannounced Inspection Work Plan" that the 2022 medical insurance fund unannounced inspection targets nationwide designated medical institutions and county-level medical insurance agencies, and can be extended to inspect relevant institutions and agencies as appropriate. Insured person.
Going back to the specific arrangements for nationwide unannounced inspections, on May 27, four ministries and commissions, the National Medical Insurance Administration, the Ministry of Finance, the National Health Commission, and the State Administration of Traditional Chinese Medicine, jointly announced that they would organize and carry out inspections covering 31 provinces, autonomous regions, municipalities directly under the Central Government and An unannounced inspection of the medical insurance fund of the Xinjiang Production and Construction Corps. This unannounced inspection will be time framed to the use of medical insurance funds since January 1, 2020, and requires a "backward inspection for two and a half years."
In the second half of this year, various provinces and cities will successively carry out intensive unannounced medical insurance inspections.
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The pharmaceutical industry continues to be shaken, and pharmaceutical and equipment companies have caused warnings.
According to incomplete statistics from Cyberland, as of now, eight provinces, including Heilongjiang, Jilin, Guangxi, Hebei, Inner Mongolia, Jiangxi, Jiangsu, and Fujian, have started unannounced inspections of medical insurance funds.
Judging from the specific content of the unannounced inspection, the inspection of designated medical institutions includes: Internal management of fund use, financial management, management of medical records, purchase, sale and inventory management of drugs and medical consumables, and decomposition of hospitalization and hanging bed hospitalization , violation of diagnosis and treatment standards, illegal charging (including illegal charging of new coronavirus nucleic acid and antigen testing fees), cross-exchange projects, illegal procurement of offline drugs, failure to purchase and use products selected by national organizations for centralized procurement as required, etc.
It is foreseeable that with the continuous deepening of medical insurance supervision, the scope of use of medical insurance funds will also be more standardized in the future. At the same time, pharmaceutical and device companies must realize that taking chances is not advisable, and core competition is the key.
Jiangsu, Guangxi, Tianjin and other provinces and cities have successively issued documents clarifying that medical institutions should strictly follow regulations to purchase drugs (medical consumables) online, and illegal offline purchases are strictly prohibited. Online purchasing rates are not high, out-of-scope emergency purchases, and institutions with data falsification. , you will be reminded, interviewed, etc.
Judging from this medical insurance unannounced inspection, while upgrading the "smart supervision" means, data analysis has also been strengthened, and supervision has become stricter.
According to the "2022 Medical Security Fund Unannounced Inspection Work Plan", the staff of the unannounced inspection team not only covers staff from the medical insurance, finance, and health departments, but also points out that there should be about 7 "third-party agency personnel" responsible for data screening. Check analysis and other work.
"Third-party agency personnel" are mostly information technology personnel, as well as some medical, pharmaceutical, financial and other professionals, who play an important role in data collection, processing, screening and analysis.
In other words, in the later unannounced inspection, online system data analysis and inspection may account for a certain proportion.
html On August 30, the Guizhou Provincial Medical Insurance Bureau and the Guizhou Provincial Public Resource Trading Center issued the "Notice on the Online Operation of the Drug and Medical Consumables Recruitment and Procurement Management Subsystem of the National Medical Security Information Platform" announcing that starting from September 1, the National Medical Security Information Platform The platform’s drug and medical consumables recruitment and procurement management subsystem is now online in Guizhou Province.
The national unified medical insurance information platform has been fully completed. It is expected that more provinces and cities will start to use it in the future, and the supervision system will also be more standardized.
Some people in the industry said that since this year, relevant departments have increased supervision, which has effectively deterred illegal activities such as bribery and corruption, medical insurance fraud, and selling with gold, and has served as a good warning to non-compliant pharmaceutical and device companies.
The above-mentioned experts further pointed out that through medical insurance unannounced inspections, medical insurance policies can be better promoted and implemented, such as the corporate supply problems that have always existed in centralized purchasing, how to make public medical institutions use more centralized purchasing drugs, and further increase the number of centralized purchasing drugs. The sustainability of the implementation of the large medical insurance payment system.
