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    亳州:大數據盯緊醫保“救命錢”
    訪問次數:2290 信息來源: 亳州晚報 發布時間:2019-06-09 07:22 文字大小:

    醫保基金是老百姓的“救命錢”,必須專款專用。市醫療保障局正在進行的專項檢查,暴露出我市部分醫藥機構存在嚴重的欺詐騙保行為。記者獲悉,我市正籌建醫保智能監控系統,緊盯“救命錢”,過度醫療、騙保都逃不過它的“法眼”。

    “醫保智能監控系統最遲今年10月底能夠上線。” 市醫療保障局基金管理科負責人程四新說,該系統可以24小時不間斷實時監控,記錄定點醫藥機構提供醫保服務行為、參保人就醫取藥過程,大數據為醫保監管提供真實有效的視頻信息,以實現就醫購藥全流程管控。

    據悉,醫保智能監控系統上線后,醫保部門可以從后臺查看到每個患者的醫保使用情況,可以隨時查看有沒有騙保、過度醫療消費等行為的發生,可以由此減少參保人和醫保服務人員違規的僥幸心理,充分保障了醫藥機構合法經營者及參保人的利益。

    從4月中旬開始,市醫療保障局對全市協議醫藥機構進行欺詐騙保行為的專項檢查。截至目前,已累計查處違規案件178起,處理142家醫療機構;解除1家協議藥店;暫停34家協議藥店;核減530.52萬元,拒付43.29萬元,罰款117.98萬元,涉及總金額691.79萬元。

    程四新表示,檢查中的問題暴露了我市部分醫藥機構存在降低標準住院、掛床住院、分解住院、虛假治療、過度診療、違規收費、串換藥品等欺詐騙保行為十分嚴重,監管形勢較為嚴峻。

    “目前專項檢查仍在繼續,將持續到11月份。”程四新表示,專項檢查通過四種方式進行。一是醫療保障局組織人員,對舉報線索、上級交辦的大案要案進行查處; 二是醫保經辦機構成立醫保稽查大隊,對轄區內醫療機構、協議零售藥店、參保人員欺詐騙保行為,進行日常全面稽查;三是醫共體牽頭單位建立專家庫,輪流抽調專家對醫共體內的醫療機構存在的欺詐騙保行為進行日常檢查; 四是商業保險公司,聘請專家成立若干稽核小組對所有醫保住院病例進行全面審核。

    據了解,根據2018年6月1日起施行的《安徽省基本醫療保險監督管理暫行辦法》明確:對用人單位、參保人員、協議醫療機構、協議藥店騙取醫療保險基金的,由醫保行政部門責令退回,并處騙取金額2倍以上5倍以下的罰款;對經辦機構及其工作人員騙取或者協助他人套取、騙取醫療保險基金造成損失的,依法承擔賠償責任。(記者 李錦文)

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