First, the background and objectives of self-examination and self-correction
With the deepening of medical reform and the improvement of medical insurance system, the use and management of medical insurance fund has become one of the tasks that medical institutions must pay attention to. The purpose of this self-examination and self-correction is to fully understand the use of medical insurance funds in this institution, find out the existing problems, and take corresponding rectification measures to ensure the compliance and effectiveness of the use of medical insurance funds.
Second, the process of self-examination and self-correction
1. Set up a self-inspection team: set up a self-inspection team composed of personnel from finance, medical care, medical insurance and other relevant departments to be responsible for the organization and implementation of this self-inspection and self-correction.
2. Make a self-inspection plan: According to the actual situation of this institution, make a detailed self-inspection plan, and define the scope, content and methods of self-inspection.
3. Carry out self-inspection: According to the self-inspection plan, conduct a comprehensive inspection of the use of medical insurance funds in institutions, including fund income, expenditure and settlement.
4. Find problems and record them: record the problems found in the self-inspection, analyze the causes and effects of the problems, and put forward corresponding rectification measures.
Third, the results of self-examination and self-correction
Through self-examination, we found the following problems:
1. Some doctors don't know the medical insurance policy deeply enough, which leads to irregular behavior in the process of prescription and diagnosis and treatment.
2. The settlement process of medical insurance fund is not standardized, and some expenses are not settled in time or accurately.
3. The supervision of the use of medical insurance funds is not strict enough, and there are individual violations.
In view of the above problems, we propose the following rectification measures:
1. Strengthen medical insurance policy training, improve doctors' mastery of medical insurance policy, and standardize diagnosis and treatment behavior.
2. Optimize the settlement process of medical insurance fund, strengthen financial audit and supervision, and ensure the accuracy and timeliness of expense settlement.
3 to strengthen the supervision of the use of medical insurance funds, establish and improve the internal control mechanism to prevent violations.
Fourth, the implementation and effect of rectification measures
We have begun to implement the above corrective measures and achieved initial results. By strengthening medical insurance policy training, doctors' diagnosis and treatment behavior is more standardized; By optimizing the settlement process of medical insurance fund, the accuracy and timeliness of expense settlement are improved; By strengthening the supervision of the use of medical insurance funds, violations have been effectively curbed.
To sum up:
The self-examination and self-correction of the use of medical insurance funds have achieved positive results. We have found existing problems and taken corresponding rectification measures. In the next step, we will continue to strengthen the supervision and management of the use of medical insurance funds to ensure the safe and effective use of medical insurance funds and provide better medical services for patients.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 87 provides that:
Social insurance agencies, medical institutions, pharmaceutical trading units and other social insurance service institutions defraud social insurance fund expenditures by fraud, forgery of certification materials or other means, and the social insurance administrative department shall order them to return the defrauded social insurance money and impose a fine of more than 2 times and less than 5 times the amount defrauded; If it belongs to a social insurance service institution, the service agreement shall be terminated; If the directly responsible person in charge and other directly responsible personnel are qualified, their qualifications shall be revoked according to law.
People's Republic of China (PRC) social insurance law
Article 88 provides that:
Whoever defrauds social insurance benefits by fraud, forgery of certification materials or other means shall be ordered by the social insurance administrative department to return the defrauded social insurance benefits, and a fine of not less than two times but not more than five times the amount defrauded shall be imposed.