The National Medical Insurance Bureau published a case on WeChat WeChat official account on September 26th.
Summary of the case:
The staff of the Medical Insurance Bureau of Yiling District, Yichang City, Hubei Province received a report from the masses that a clinic was suspected of swapping drugs for settlement, resulting in the loss of the medical insurance fund. The local medical insurance bureau quickly launched an investigation and found that the drug exchange behavior of the pharmacy was true. The medical insurance department interviewed the person in charge of the clinic, recovered the illegal fund, and imposed a penalty of 2 times the illegal amount.
Case analysis:
According to the provisions of Article 38 of the Regulations on the Supervision and Administration of the Use of Medical Security Funds, if a designated medical institution exchanges drugs, medical consumables, diagnosis and treatment items and service facilities, the administrative department of medical security shall order it to make corrections, and may interview the relevant person in charge; Causing losses to the medical insurance fund, it shall be ordered to return, and a fine of more than 1 time and less than 2 times the amount of losses shall be imposed; Refusing to correct or causing serious consequences, the designated medical institutions shall be ordered to suspend the medical services involved in the use of medical security funds by the relevant responsible departments for more than 6 months and less than 1 year; Violation of other laws and administrative regulations shall be dealt with by the relevant competent departments according to law. ("National Medical Insurance Bureau" WeChat WeChat official account)