Recently, the "Measures for the Supervision and Administration of Shanghai's Basic Medical Insurance (Draft)" formulated by the Shanghai Municipal Government has been publicly solicited for opinions. According to the "draft" regulations, medical institutions that violate regulations may be fined up to 100,000 yuan.
The "Draft" stipulates that fixed-point medical institutions and designated retail pharmacies fail to verify the basic medical insurance voucher as required, and use basic medical insurance voucher for medical treatment or dispensing for basic medical insurance cost settlement; or take duplicate registration, duplicate or no There are seven types of violations, such as laboratory tests, examinations, treatments, decomposing or hospitalization without indications, fictitious or provision of unnecessary medical services for the settlement of basic medical insurance costs, and the Shanghai Human Resources and Social Security Bureau shall order them to make corrections. Recover relevant basic medical insurance expenses that have been paid by the medical insurance fund, and may impose warnings or fines ranging from 3,000 yuan to 100,000 yuan; if the circumstances are serious, you may also suspend the settlement of basic medical insurance for one month to six months. Relationships or cancellation of their basic medical insurance qualifications.
At the same time, the Shanghai Medical Insurance Supervision and Inspection Institute should conduct real-time monitoring of the number of emergency medical visits to the insured personnel and their basic medical insurance costs. If the number of medical emergencies and the amount of basic medical insurance incurred exceeds the prescribed range, measures may be taken to temporarily change the method of accounting for the basic medical insurance expenses of the outpatient emergency department. In the case of seeking medical treatment or purchasing drugs, there are five types of infringements that involve the lending of the personâ€™s basic medical insurance certificate to others, or the settlement of basic medical insurance costs through paid transfer of medical treatment vouchers or settlement documents, Shanghai Human Resources and Society. The Bureau of Security shall order it to return the relevant basic medical insurance expenses already paid by the medical insurance fund, and may impose a warning or a fine of not less than 100 yuan but not more than 2,000 yuan; if the circumstances are serious, a fine of not less than 2,000 yuan but not more than 10,000 yuan shall be imposed; Take measures to change the basic medical insurance expense settlement method for 1 month to 6 months.
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