What does medical insurance flight inspection mean?

Legal analysis: 1. Investigate and deal with medical price violations included in the scope of medical insurance;

2. Supervise and inspect medical assistance;

3. Supervise and inspect the compliance of employers and individuals with social insurance laws and regulations;

4 to strengthen the supervision and management of medical services and medical expenses included in the payment scope of the basic medical insurance fund;

5. Supervise and inspect the compliance of centralized procurement of high-value medical consumables in public medical institutions;

6. Supervise and inspect the compliance of centralized drug procurement in public medical institutions;

7. Monitoring drug price and cost survey;

8. To supervise and inspect the information provided by drug marketing license holders, drug production enterprises, drug trading enterprises and medical institutions to the competent department of drug prices on the actual purchase and sale prices and purchase and sale quantities of their drugs;

9. Medical insurance audit.

Legal basis: Notice of the National Health Insurance Bureau on Doing a Good Job in the Supervision of Medical Insurance Funds 20 19 1. Intensify the crackdown and consolidate the high-pressure situation.

(1) Full coverage of supervision and inspection. Improve the working mechanism and consolidate the high-pressure situation of fund supervision. All co-ordination areas should integrate the resources of all parties, concentrate special efforts, innovate working methods, and investigate the violations of laws and regulations of designated medical institutions within their jurisdiction one by one to achieve full coverage of on-site inspections of designated medical institutions. It is necessary to comprehensively use intelligent monitoring, surprise inspection and expert review. , the medical insurance fund payment will be included in the scope of post-event audit, and the interception and pre-warning will be accelerated. Provincial medical insurance departments should strengthen overall planning, overall coordination, supervision and inspection, and conduct spot checks on designated medical institutions in the overall planning area in a timely manner, with a spot check ratio of not less than 10%.

(2) Carry out special treatment. On the basis of comprehensive inspection, a special campaign to crack down on fraud and insurance fraud was launched on 20 19. On the basis of the 20 18 special action to crack down on fraudulent insurance, all provinces should, in light of local conditions and weak links, determine the key points of 1-2 special treatment and concentrate on cracking down severely. Before the end of March, study and formulate a unified special treatment work plan for the whole province and report it to the National Medical Insurance Bureau for the record; From April to August, the overall planning area carried out special governance self-inspection work; 109-June, the provincial medical insurance department conducted spot check and review, and submitted the summary of special treatment work to the National Medical Insurance Bureau before the end of June.

(3) Conducting flight inspections. The National Health Insurance Bureau will establish a flight inspection mechanism, gradually improve the flight inspection workflow and operational norms, and supervise and guide local work through unscheduled flight inspections. After receiving the notice of flight inspection, the provincial medical insurance departments should be serious about work discipline, actively cooperate with the inspection, and complete the follow-up investigation of flight inspection as required.

(4) highlight the key points. According to the characteristics of frequent and high incidence of illegal activities of different regulatory objects, focus on key points, classify and crack down, and formulate corresponding policies. For designated medical institutions, it is necessary to further determine the supervision focus according to their service characteristics. Public medical institutions above the second level should focus on investigating and dealing with illegal acts such as decomposing fees, overcharging, repeated fees, applying project fees, and unreasonable diagnosis and treatment; Primary medical institutions, focusing on the investigation of hanging bed hospitalization, dispensing drugs, consumables and diagnosis and treatment projects; Social medical institutions focus on investigating and dealing with behaviors such as inducing insured persons to be hospitalized, fabricating medical services, forging medical documents and bills, hanging up beds for hospitalization, and stealing social security cards. For designated retail pharmacies, we will focus on investigating and collecting stolen social security cards and inducing insured people to buy cosmetics and daily necessities. For the insured, we will focus on investigating and dealing with acts such as forging false bills for reimbursement, seeking medical treatment under false names, cashing out or taking medicine with social security cards, and buying and selling consumables. For medical insurance agencies (including commercial insurance agencies that undertake basic medical insurance and serious illness insurance), it is necessary to strengthen supervision and inspection, focusing on investigating and dealing with behaviors such as imperfect internal audit system, incomplete fund audit, inadequate performance inspection, illegal medical insurance treatment, illegal payment of medical insurance fees, "inside job theft" and "internal collusion" by internal personnel.