Shanxian County of Shandong notified the “village stroke” incident: the village doctor was arrested on suspicion of fraud
2021-10-20 11:31:38Source: CCTV News Client
The Shanxian County People’s Government website reported on October 20 that the Shanxian Joint Investigation Team issued a notice on the 20th. On October 19th, the National Medical Insurance Bureau and the Provincial Medical Insurance Bureau’s supervision team moved into Shan County to supervise and supervise relevant issues exposed by the media on the spot. Take the case as a guide and draw inferences from one another, seriously investigate and deal with the chaos and fraudulent insurance practices in grass-roots medical institutions, and earnestly safeguard the interests of the people and the safety of medical insurance funds.
According to the preliminary investigation by the joint investigation team, from 2016 to 2019, the primary health clinics in Shan County need to use the “Management Information System for Primary Medical and Health Institutions in Shan County” when seeing a doctor. According to the operating procedures, village doctors need to register disease information before issuing For prescriptions, disease information can be entered in two ways: the disease number and the initials of the disease name. The village doctor Zhu Mouju did not truthfully enter the correct disease name in accordance with the operating specifications. This saves time and trouble. Only by double-clicking the space bar, the “brain stroke” with the disease number “0001” directly generates disease information by default, resulting in a large number of villagers Was “stroke”. Currently, the verified error information has been corrected.
According to the joint investigation team’s verification, village doctor Zhu Mouju was greedy for profit and used false reports of medical records to defraud residents’ basic medical insurance outpatient coordinating funds. For every false report of medical records, 5 yuan of medical fees can be collected. During the nearly six years from January 2016 to September 2021, the clinic had a total of 49,633 medical records, involving a total amount of 564,395.29 yuan, and the actual reimbursement of the residents’ basic medical insurance outpatient co-ordination fund was 376,968.03 yuan (including 248,165 yuan for diagnosis and treatment, 128803.03 yuan for medicines) . Among them, the largest medical expense was 50.2 yuan, and the actual reimbursement was 27.1 yuan; the smallest medical expense was 1.84 yuan, and the actual reimbursement was 0.92 yuan. At present, the public security organs of Shanxian County are verifying the illegal income obtained by fraudulent use of personal information and false report of diagnosis and treatment records one by one.
On October 19, the Shan County Public Security Bureau detained Zhu Mouju, the village doctor suspected of fraud, according to the facts of the investigation. The inspection and investigation team of the Commission for Discipline Inspection and Supervision has been stationed in health, medical insurance and other units to conduct investigations, and will seriously investigate and deal with problems such as dereliction of duty and dereliction of duty. At the same time, the county launched a special campaign to rectify primary medical and health institutions and combat fraudulent insurance, comprehensively standardize diagnosis and treatment behavior, further strengthen the supervision of medical insurance funds, improve the long-term mechanism of primary medical institution management and medical insurance fund supervision, and ensure that the interests of the people are not infringed. Relevant review and investigation work is being carried out in an orderly manner.
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