In March 2022, the National Medical Insurance Bureau, together with the Health and Health Commission and the State Administration of Market Supervision, conducted a flight inspection on tongji hospital (referred to as "tongji hospital") affiliated to Tongji Medical College of Huazhong University of Science and Technology. The relevant person in charge of the National Medical Insurance Bureau informed that, after investigation, it was found that during the period of 20171-September 2020, tongji hospital had the problem of replacing and falsely listing the high medical expenses of orthopedics, and defrauded the medical insurance fund to pay 23,343,609.64 yuan. How to understand it? Simply put, it is shoddy. For example, hospital bills record tens of thousands of consumables, but patients may use cheap materials at low prices. This is everyone's life-saving money. Is there still humanity? Is there a royal law? As one of the top ten star hospitals in China, tongji hospital is really ignorant. Now it has become the protagonist of the insurance fraud case, not only punished by Wuhan Medical Insurance Bureau, but also condemned by the whole society.

Wuhan Medical Insurance Bureau made this treatment according to the Social Insurance Law of People's Republic of China (PRC) and the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds:

1, ordered to rectify;

2. Fined the hospital 38,365,438+04,924.20 yuan, ordered the hospital to conduct self-examination and voluntarily returned the defrauded medical insurance fund of 65,438+0965,438+057,462 462. 10/0 yuan; A fine of 20,930,737.70 yuan was imposed on the fraud amount of 4 186 147.54 yuan found in the inspection, totaling 592,4561.90 yuan;

3, ordered the hospital to suspend medical services involving the use of medical insurance funds for 8 months;

4, according to the law and regulations to the public security, market supervision, drug supervision, health, discipline inspection and supervision and other relevant departments to transfer case clues. At present, all the losses of the medical insurance fund have been returned and all the fines have been implemented.

Moreover, the flight inspection also found many other problems. In the next step, Hubei Medical Insurance Bureau and Wuhan Medical Insurance Bureau will be responsible for the division of labor, review other issues, and urge tongji hospital to carry out rectification; At the same time, it is also necessary to protect the rights and interests of the insured people, suspend the service period of orthopedic medical insurance in hospitals, and guide patients to other hospitals for orthopedic treatment.

To this, tongji hospital also responded.

This serious rectification and punishment is a warning to institutions and doctors.

First of all, through this incident, we should understand that it is not only private hospitals but also public hospitals that crack down on insurance fraud in China, and there may be more problems. For a long time, everyone seems to have entered a misunderstanding on the issue of fraudulent insurance, especially the managers and medical staff in public hospitals. They always feel good about themselves, but they don't know that the problem is everywhere.

Secondly, I really don't understand that many hospitals have such cognition now. They regard irregular medical behavior as a common occurrence, and they don't understand and don't want to understand that medical insurance fund is a livelihood fund for saving lives. What is even more hateful is that some hospital managers regard patients and subsidies as political achievements, and their medical behavior is in a mess and they are unwilling to change. Now we must start to control. Some hospitals should not distinguish between good and bad, and their concepts should be changed. They should do more practical things for the people. It is illegal to take medical insurance funds in violation of regulations.

In addition, the current medical insurance informatization is progressing steadily with good results. Management is changing from managing hospitals to managing doctors. In the future, various systems will be more perfect, the information management of medical insurance will surely reach a new level, and supervision will also change from management results to management processes. If you break the rules, I will directly limit your behavior. Doctors will be responsible for their actions, and institutions and doctors will influence each other.

I believe that any illegal act that infringes on the medical insurance fund and people's health will eventually pay the price. Now the relevant departments have begun to severely punish, and the effect of this incident in tongji hospital should be obvious to all in the industry.