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class="article-icon fontsize"> <i class="print" title="打印" onclick="javascript:window.print();"></i><i class="l" id="f-add" title="字體大"></i><i class="s" id="f-dec" title="字體小"></i></span> </div> <div id="o4vmx3ylh2" class="article-content article-content-body" id="zoomcon"> <p style="text-align: justify;"><br/></p><p style="text-align: center;">　　<a target="_blank"><img title="關(guān)于8起欺詐騙取醫(yī)?；鸬湫桶咐耐▓?png" src="http://xlyzsl.cn/img/0/102/102202/1186045.png" style="float: none;" srcset="" class="nfw-cms-img" img-id="102202" data-catchresult="img_catchSuccess"/></a></p><p><br/></p><p style="text-align: justify;">　　2018年9月起，國家醫(yī)保局會同國家衛(wèi)健委、公安部、國家藥監(jiān)局聯(lián)合開展打擊欺詐騙取醫(yī)療保障基金專項行動。專項行動開展以來，各地加大打擊力度，依法依規(guī)查處了一批欺詐騙保案件?，F(xiàn)將首批8起案例通報如下：</p><p style="text-align: justify;"><strong>　　一、內(nèi)蒙古自治區(qū)呼倫貝爾市牙克石市圖里河鎮(zhèn)中心衛(wèi)生院以虛假住院騙取醫(yī)?；鸢?/strong></p><p style="text-align: justify;">　　經(jīng)查，內(nèi)蒙古自治區(qū)呼倫貝爾市牙克石市圖里河鎮(zhèn)中心衛(wèi)生院存在疑似違規(guī)病歷207份，存在過度檢查、過度診斷、過度醫(yī)療等違反協(xié)議管理行為。其中2016年6月至2017年10月，虛假住院7例，涉及醫(yī)?；?.2萬元。醫(yī)保部門依據(jù)《中華人民共和國社會保險法》第八十七條、《內(nèi)蒙古自治區(qū)城鎮(zhèn)基本醫(yī)療保險條例》第五十四條以及《呼倫貝爾市城(鄉(xiāng))基本醫(yī)療保險定點醫(yī)療機構(gòu)(一級綜合)服務(wù)協(xié)議書》規(guī)定，追回醫(yī)?；?.2萬元，并處5倍罰款11萬元。衛(wèi)計部門對該衛(wèi)生院負(fù)責(zé)人作出停止工作決定，并對相關(guān)違法違紀(jì)工作人員進行處理。</p><p style="text-align: justify;"><strong>　　二、安徽省淮南市毛集第二醫(yī)院以虛假住院騙取阜陽市潁上縣醫(yī)保基金案</strong></p><p style="text-align: justify;">　　經(jīng)查，淮南市毛集第二醫(yī)院以免費體檢為由，獲取阜陽市潁上縣參合群眾信息，編造住院治療材料，套取新農(nóng)合基金。2016年8月至2018年8月，該院共編造450人次虛假住院信息，騙取新農(nóng)合基金136萬元。醫(yī)保部門依據(jù)《安徽省基本醫(yī)療保險監(jiān)督管理暫行辦法》第十七條、第三十八條以及《新型農(nóng)村合作醫(yī)療定點醫(yī)療機構(gòu)違法違規(guī)行為查處辦法》第十四條、第十五條規(guī)定，終止與淮南市毛集第二醫(yī)院醫(yī)保服務(wù)協(xié)議，并將有關(guān)線索移交公安機關(guān)立案調(diào)查。經(jīng)潁上縣人民檢察院批準(zhǔn)，公安機關(guān)已刑事拘留6人，取保候?qū)?人，網(wǎng)上追逃2人。衛(wèi)計部門依據(jù)《醫(yī)療機構(gòu)管理條例實施細(xì)則》第七十九條規(guī)定，吊銷該院《醫(yī)療機構(gòu)執(zhí)業(yè)許可證》。</p><p style="text-align: justify;"><strong>　　三、江西省萍鄉(xiāng)市安源區(qū)人民大藥房串換藥品騙取醫(yī)?；鸢?/strong></p><p style="text-align: justify;">　　經(jīng)查，江西省萍鄉(xiāng)市安源區(qū)人民大藥房2017年1月至2018年10月，醫(yī)保系統(tǒng)內(nèi)銷售數(shù)據(jù)大于其店內(nèi)銷售數(shù)據(jù)，存在替換、串換藥品等問題，涉及金額4.9萬元。醫(yī)保部門依據(jù)《萍鄉(xiāng)市基本醫(yī)療保險定點零售藥店服務(wù)協(xié)議》第三十三條規(guī)定，追回違規(guī)銷售藥品費用4.9萬元，并暫停其醫(yī)保服務(wù)協(xié)議3個月。</p><p style="text-align: justify;"><strong>　　四、湖北省黃岡市蘄春縣五洲醫(yī)院套取醫(yī)?；鸢?/strong></p><p style="text-align: justify;">　　經(jīng)查，湖北省黃岡市蘄春縣五洲醫(yī)院于2018年8月，通過掛床住院、以體檢為由誘導(dǎo)住院、無醫(yī)囑用藥等方式，騙取醫(yī)?；?.1萬元。醫(yī)保部門依據(jù)《黃岡市基本醫(yī)療保險醫(yī)療機構(gòu)服務(wù)協(xié)議書》第五十條、第五十一條、第五十二條、第五十三條、第五十四條之規(guī)定，約談該院負(fù)責(zé)人，責(zé)令其立即停止違規(guī)行為。從2018年11月16日起暫停該院的醫(yī)保定點資格，按照違規(guī)金額的5倍從該醫(yī)院醫(yī)保結(jié)算款中扣減20.5萬元，并移交衛(wèi)計部門進一步查處。</p><p style="text-align: justify;"><strong>　　五、湖南省茶陵縣洣江衛(wèi)生院虛構(gòu)五保戶住院騙取醫(yī)?；鸢?/strong></p><p style="text-align: justify;">　　經(jīng)查，洣江衛(wèi)生院院長雷某指使醫(yī)生聯(lián)系洣江敬老院，假借為洣江敬老院五保戶體檢的名義，收集敬老院五保戶花名冊，于2018年2月對劉某、陳某等28名五保戶以掛床住院、虛構(gòu)費用的方式違規(guī)辦理住院手續(xù)，并安排衛(wèi)生院工作人員制作虛假醫(yī)患交流記錄、病歷診斷書、處方等相關(guān)資料，違規(guī)套取醫(yī)?；?.6萬元。醫(yī)保部門依據(jù)《茶陵縣基本醫(yī)療保險定點醫(yī)療機構(gòu)管理監(jiān)督辦法(試行)》第二十條、《茶陵縣基本醫(yī)療保險定點醫(yī)療機構(gòu)服務(wù)協(xié)議書》第四十七條規(guī)定，關(guān)停該院醫(yī)保報銷系統(tǒng)，暫停醫(yī)保服務(wù)，責(zé)令全面整改，追回套取醫(yī)?；?.6萬元，并按違規(guī)費用的5倍拒付醫(yī)?；?，并建議衛(wèi)計部門對該院相關(guān)醫(yī)務(wù)人員作出處理。紀(jì)檢監(jiān)察部門給予雷某黨內(nèi)嚴(yán)重警告處分，并給予該院6名相關(guān)工作人員誡勉談話處理。</p><p style="text-align: justify;"><strong>　　六、重慶市開州區(qū)普渡村衛(wèi)生室騙取醫(yī)保基金案</strong></p><p style="text-align: justify;">　　經(jīng)查，重慶市開州區(qū)普渡村衛(wèi)生室和智慧藥品超市負(fù)責(zé)人均為李某，該村衛(wèi)生室于2018年2月至2018年11月，通過刷卡報銷智慧藥品超市藥品費用、串換藥品等方式騙取醫(yī)保基金20.09萬元。醫(yī)保部門依據(jù)《重慶市醫(yī)療保險協(xié)議醫(yī)療機構(gòu)醫(yī)療服務(wù)協(xié)議》第二十五條和《重慶市開州區(qū)醫(yī)療保險村衛(wèi)生室(社區(qū)衛(wèi)生服務(wù)站)醫(yī)療服務(wù)協(xié)議》第十九條之規(guī)定，暫停其醫(yī)保網(wǎng)絡(luò)結(jié)算3個月，暫停李某醫(yī)保醫(yī)師資格6個月，追回違規(guī)費用20.09萬元，并處1倍違約金，拒付該村衛(wèi)生室2018年度一般診療費用1.35萬元，責(zé)令智慧藥品超市限期整改。</p><p style="text-align: justify;"><strong>　　七、四川省達(dá)州市仁愛醫(yī)院誘導(dǎo)病人住院騙取醫(yī)?；鸢?/strong></p><p style="text-align: justify;">　　經(jīng)查，四川省達(dá)州市仁愛醫(yī)院于2018年1月至2018年6月，采取免收病人自付費用、車輛接送、出院贈送棉被和藥品等方式誘導(dǎo)病人住院，通過多記、虛記費用的方式騙取醫(yī)保基金9.03萬元。醫(yī)保部門依據(jù)《中華人民共和國社會保險法》第八十八條、《通川區(qū)基本醫(yī)療保險定點醫(yī)療機構(gòu)服務(wù)協(xié)議》第五十六條、第五十七條規(guī)定，追回違法違規(guī)費用9.03萬元，并處5倍罰款45.15萬元，取消該院醫(yī)保定點醫(yī)療機構(gòu)資格。衛(wèi)計部門依據(jù)《醫(yī)療機構(gòu)管理條例》第四十八條規(guī)定，吊銷該院《醫(yī)療機構(gòu)執(zhí)業(yè)許可證》，并處罰款34.2萬元。公安部門依法逮捕2人，取保候?qū)?人。紀(jì)檢監(jiān)察部門對人社(醫(yī)保)、衛(wèi)計部門相關(guān)工作人員給予紀(jì)律處理。</p><p style="text-align: justify;"><strong>　　八、甘肅省天水市秦安中西醫(yī)結(jié)合醫(yī)院誘導(dǎo)病人住院騙取醫(yī)?；鸢?/strong></p><p style="text-align: justify;">　　經(jīng)查，甘肅省天水市秦安中西醫(yī)結(jié)合醫(yī)院于2018年1月至2018年10月，通過過度治療、將可門診治療的參保個人收治住院、以免費體檢為由誘導(dǎo)參保人員住院等方式騙取醫(yī)保基金13.62萬元。醫(yī)保部門依據(jù)《中華人民共和國社會保險法》第七十九條、第八十二條、《甘肅省城鄉(xiāng)居民基本醫(yī)療保險定點醫(yī)療機構(gòu)違約行為基金扣減辦法(附件)》第八條、第十二條、第十三條、第十四條以及《天水市醫(yī)療保險定點醫(yī)療機構(gòu)醫(yī)療服務(wù)協(xié)議》第五十條、第五十一條、第五十二條規(guī)定，從2018年12月11日起解除該院醫(yī)保服務(wù)協(xié)議，取消該院醫(yī)保定點醫(yī)療機構(gòu)資格，追回違法違規(guī)費用13.62萬元，并處5倍罰款68.1萬元，追回審計發(fā)現(xiàn)的多收床位費、分解住院、擴大報銷范圍違規(guī)報銷基金2.95萬元。</p><p><br/></p> </div>  <div id="o4vmx3ylh2" class="attach"> ???????????????????????????????????????????????????????</div> ???????????????????????? <div id="o4vmx3ylh2" class="article-relDocuments tab-brief sign"> <div id="o4vmx3ylh2" class="hd clearfix"> <ul> <li id="o4vmx3ylh2" class="on"><a href="">相關(guān)信息</a></li> </ul> </div> <div id="o4vmx3ylh2" class="bd"> <div id="o4vmx3ylh2" class="item"> <ul class="newsList yyyy-MM-dd"> </ul> </div> </div> </div>?????????????????</NFC_INCLUDE>    <dl class="article-ewm"> <dt 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