On April 17, Chen, a doctor of Shenzhen People's Hospital, Cui Mou of Shenzhen Third People's Hospital, and a doctor of Nanshan District People's Hospital were suspected of colluding with lawless elements to carry out medical insurance (see the article after the specific report), causing widespread attention.
Many doctors participate in cash
According to reports, this group of criminals has been engaged in such activities for a long time, and their presence frequently appears in many public top three hospitals in Shenzhen, and there are regular hospital doctors to “escort†them.
The reporter said that most of the people who participate in social security cash out are social idlers. They give the regular doctors a considerable return, prompting doctors to prescribe fake prescriptions, so that they can get prescription drugs at the hospital pharmacy, and then sell the prescription drugs through the underground market. .
This obviously has touched the legal red line. Article 88 of the "Social Insurance Law of the People's Republic of China" stipulates that if fraudulent or forged documents or other means are used to defraud social insurance benefits, the social insurance administrative department shall order the return of the social insurance funds defrauded, and the amount of fraudulent acquisition shall be more than 2 times and 5 times. The following fine.
According to Article 73 of the Drug Administration Law of the People's Republic of China, if the drug is not obtained from the Pharmaceutical Business License, it will be banned according to law, and the relevant departments may confiscate the illegally sold drugs and illegal income. A fine of 2 to 5 times the value of the illegally sold drugs (including those sold and unsold) will be imposed; if a crime is committed, criminal responsibility will also be pursued.
The doctor was suspended for investigation
The Shenzhen Social Security Bureau and the Health Planning Commission also responded quickly. The Shenzhen Health Planning Commission issued an announcement. The doctor of the Shenzhen People's Hospital Chen, the doctor of the Third People's Hospital of the city Cui, and the doctor of Nanshan District People's Hospital have been suspended by the hospital. Prescription rights, suspension of employment and investigation.
The Shenzhen Municipal Health Planning Commission requested the Municipal Medical Management Center and the health administrative departments of various districts to seriously investigate and verify, and investigate the responsibility of those directly responsible for the incident and the responsible persons in accordance with the law.
The Shenzhen Social Security Zone said that it has formed three law enforcement teams to go to the hospitals involved in the investigation and report to the public security department, and hand over the possible fraudulent insurance coverage to the public security organs.
Medical insurance intelligent control fees have been launched nationwide
At present, according to reports, the Shenzhen Municipal Social Security Bureau has promoted the construction of the “Smart Health Insurance†audit platform in seven hospitals, using information technology to strengthen medical insurance monitoring and early warning and actuarial decision-making. The next step is to promote the use of the platform to all designated hospitals and pharmacies in the city. .
Earlier, Yang Yanwei, a professor at the Hospital Management Research Institute of Tsinghua University, said in an interview with the media: "Before the end of 2016, all parts of the country plan to go online for a comprehensive medical insurance audit system, and doctors' unreasonable prescribing behavior will be banned or warned."
According to reports, the intelligent audit system will review the drug behavior that does not meet the routine of diagnosis and treatment, clinical norms, does not meet the standard, does not allow medical insurance reimbursement, beyond the scope of payment, to achieve medical insurance control fees.
This time, the Shenzhen Health Planning Commission also quickly shot, not only sent people to investigate, but also emphasized the smart medical insurance audit system, apparently hope to eliminate such incidents from the system.
Nandu secretly visited medical insurance cash! Doctors in the top three hospitals in Shenzhen are madly forging medical records, and the degree of boldness is staggering.
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