The social insurance of Shenzhen office responds and fishes to enforce the law: In charge of seeing the doctor the money bag in order to join sponsors

The social insurance of Shenzhen office responds and fishes to enforce the law: In charge of seeing the doctor the money bag in order to join sponsors
Take the medical insurance card not belonging to oneself and goes to a doctor, disguises oneself as the emergency call and does not give the doctor a nuclear card chance Recently, Shenzhen many of the intersection of society and the intersection of health and centre mean municipal staff member, office of social insurance, this disguise oneself as patient, induce doctor diagnose the illness nuclear Carlos, and regard this as the punishment basis.
On November 16, the centre of social insurance of Shenzhen investigates to staff members secretly and enforces the law to respond, the situation that the circular supervises and inspects to the fixed medical organization and method to pay and is supervised and inspected.
Refer to the social insurance office in the health centre of the society " Fish and enforce the law "
The social insurance office reflected in fixed society health centre of the medical insurance investigates the way of law enforcement secretly, it is mainly three kinds: The staff members of the social insurance go to a doctor with the others' medical insurance card with very similar one's own appearance holding, make the doctor on duty difficult to distinguish; The staff members of the social insurance disguise oneself as acute disease, will let the doctor treat at once, will not give the doctor a nuclear card chance; If the doctor on duty finds the medical insurance card investigates personnel secretly and takes and disturbs the way to scold to exert pressure and let it submit not simultaneously.
It is reported, in August of this year, are punished by municipal the intersection of social insurance and office these in large societies the intersection of health and in the center and clinics of Shenzhen, the divisor of one hundred yuan is fined outside, suspend the qualification of fixed account keeping of medical organization of the medical insurance. Reason to by investigate secretly, site inspection investigation, find " doctor give effect an insurance patient diagnose the illness nuclear Carlos, ledger clerk's not nuclear card, cause Medical Benefits Funds to run off " .
"Supervise management to be all right, but why want, take this kind fish way that enforce the law? " Many one is punished in the health centre of the society and exploded the material to the local media, the person in charge of the health centre of the society queries the social insurance office " fishes and enforces the law " . Society the intersection of health and centre say social insurance office delay, paste up the intersection of medical insurance and punishment of Carlos to the intersection of society and the intersection of health and centre also, lead to the fact the nearby patient, seek medical advice inconvenient, because during this period, residents can't brush the medical insurance card at the place where punished in the health centre of the society.
The agreements of both sides stipulate that can be investigated secretly
Criticism and local media to the health centre of the society report, the relevant persons in charge in the centre of social insurance of Shenzhen say, this actually reflects the social insurance is stricter in fund management, do not break, distribute money arbituarily arbitrarily.
The intersection of social insurance of Shenzhen and in the center recommend, the relation between social insurance organization and hospital is the third party's relation of supervision and management. The hospital offers medical treatment service, join sponsors and accept medical care, the social insurance is joined the sponsor trusting, according to the agreement with agreement of the medical safety unit, whether agree to provide service, violate legal provisions and use the National Social Security Fund (NSSF) to supervise and inspect to the medical safety unit by fixed position according to the agreement.
This person in charge points out: "The treatment to fixed medical organization of social insurance organization, it is according to appointed agreements of both sides, agree on offering medical care behavior that noncompliance handles, corrects not according to agreement to fixed medical organization, a contract behavior is not the behavior of enforcing the law. "
It is reported, according to the relevant regulations of " social medical insurance method in Shenzhen ", " fixed management of medical organization of the social medical insurance of Shenzhen ", the social safety unit of Shenzhen retails the pharmacy to sign the agreement with the fixed medical organization and by fixed position. Agreement regulation, the social safety unit can adopt special examination, spot check, inspection, investigate secretly on the spot, the intersection of computer and the intersection of person who control and method that way combine serve for joining the medical treatment that sponsors offered, go on, check to fixed medical organization, can also engage the social insurance supervisor, observe the fixed social insurance policy implementation of medical organization publicly and investigate privately, supervise on the spot.
To fixed the intersection of supervision and inspection and content of medical organization, raise the price in violation of rules and regulations medicines mainly, violation charge, join the intersection of sponsor and expenses, timid the intersection of person who prescribe and unlawful practice more.
To the handling which the situation social insurance department in violation of rules and regulations takes, rectify and improve, circulate a notice of criticism, suspend the fixed qualification of social insurance for 3-12 months, cancel the fixed qualification of the social insurance within a definite time period.
Check and find serious adding the medicine price in violation of rules and regulations and is up to 14 times
The intersection of social insurance of Shenzhen and office recommend, this office, according to controlling on the net, find the phenomenon that the expenses of account keeping of the medical insurance unusually increase appears in some fixed medical organizations, from the beginning of this year, have strengthened the supervision inspection to the fixed medical organization. "Investigate to the relevant fixed medical organization, take and observe publicly and investigate privately, transfer the prescription and treats singly and keep accounts to check with the computer more than the right, data materials way of checking the medicines stock movement in and out of the warhouse list etc. live. "
It is introduced, verify through investigating, the social insurance department finds some fixed medical organizations have prescription treatment that keep accounts and does not accord with with the computer only, phenomena in breach of violation such as administration of ultra quantity, ultra limit administration and violating the price regulation to charge,etc., exist, see the doctor nuclear card, the intersection of ledger clerk and the intersection of nuclear card,etc. and problem to manage aspect either.
Reflect the staff members of the social insurance to the health centre of the society " Fish and enforce the law " ,Lure doctor's not nuclear card into seeing the doctor and causing the health centre of the society to be stopped the relevant business. The centre of social insurance of Shenzhen says, if the fixed medical organization has managerial defects, require doctor strict check-up seek medical advice medical card of personnel, office this to require it rectify and improve, improve, manage usually, will not suspend its fixed qualification of social insurance directly. "Social insurance focal point that department deal with to it for fixed medical organizations to be timid to prescribe to extract National Social Security Fund (NSSF), arbitrary charge, unauthorized price rise, check, damage the intersection of masses and benefit, aggravate, look at financial burden, behavior abhored by ordinary people of patient arbitrarily. "
"Suspended for 3-12 months 7 fixed medical organizations of the fixed qualification of social insurance have a serious phenomenon in breach of violationed. " The relevant persons in charge in the centre of social insurance of Shenzhen certainly say, among them the serious one adds the medicine price in violation of rules and regulations and up to 14 times.
Refer to and investigate the statement that personnel have bonus secretly to someone, the social insurance department makes explanations too: "The fixed medical organizations breaks a contract penalties paying all enter Medical Benefits Funds, will not enter in the administrative funds of the social insurance office. There is not any interests relation in result and inspector, will not release any reward to the inspector either. "
It causes influence that punishing will not see the doctor to citizens
To have the intersection of society and the intersection of health and centre reflect, suspend qualification cause citizen diagnose the illness difficult problem, the social insurance of Shenzhen office denies directly.
The reporter knows, there are 895 fixed medical organizations in all in Shenzhen at present, retail 617 pharmacies by fixed position, the fixed society health centre (including the clinic) among them 656 families, there are several fixed society health centres in many communities. Suspend some the intersection of society and the intersection of health and the intersection of centre and the intersection of medical insurance and account keeping behind the qualification, joining sponsors can go to the fixed medical organization not far away nearby to go to a doctor. The social insurance department emphasizes too, join sponsors to limit as suffering from the emergency call and seeking medical advice without tying the health centre of the society definitely.
"The social insurance organization, to the inspection of the fixed medical organization, the purpose lies in strengthening the management of the fixed medical organization, standardize fixed medical service act of medical organization, to the masses of to join sponsors, responsible for, avoid the unreasonable expense expenditure, ensure the safe and effective use of Medical Benefits Funds. " The intersection of social insurance of Shenzhen and office recommend, preliminary statistics, pass the inspection of the fixed medical organization in recent years, this office has dealt with 89 fixed medical organizations according to the appointment in accordance with the rule, the unreasonable hospitalization cost retrieving the social insured fund and paying more exceeds 10 million, have managed well and joined the money bag that sponsors saw the doctor.

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