After verification,Qionglai Minhui Hospitaletc.4Home Appointed DoctorMedicineThe institution violates the city’s basic medical security policy and service agreement. In accordance with the national, Sichuan Province and Chengdu city’s special governance requirements for combating fraudulent and defrauding medical security funds, and in accordance with the city’s basic medical< span>Insurance Designated DoctorsPharmaceuticalsAs stipulated in the institutional service agreement, the relevant violations and handling decisions are now notified as follows:
I. Qionglai Minhui Hospital violated“ “Seven Matches” Provisions
(1) Basic information on the institutions involved in the case. Qianlai Minhui Hospital, a designated medical institution in Qionglai City. Institution type: first-level medical institution, type of institution: general hospital.
(2) The main process of case investigation. 2021year12month15day, Chengdu Municipal Medical Security Bureau “Three Leaves”Special Rectification Joint Flight Inspection First Inspection Team, in accordance with the medical security fund Special treatment arrangements were made to conduct on-site inspections of Qionglai Minhui Hospital. During the inspection, the inspectors found that the hospital has: 1.There is no detection reagent for serum indirect bilirubin, and the value is calculated through calculation, and there is a charge situation, which violates the reasonable charge agreement Agreed;2.Endogenous creatinine clearance test has no detection reagent, and the value is calculated through calculation, and there is a charging situation, which violates the reasonable charging agreement;3. serum apolipoproteinaDetermination of actual serum lipoproteina It is determined that the charging items do not match the actual inspection items, which violates the reasonable charging agreement; 4. The prescription of traditional Chinese medicine is inconsistent with the charging details, which violates the regulations of “seven matches”;5 .Individual medical records violate the “Traditional Chinese Medicine Physiotherapy Specifications”;6.Individual medical records report without the signature of the doctor, which violates the special examination on medical imaging examination The stipulation that the report should be signed by a licensed physician; 7. The non-compliance of individual medical records diagnosis and treatment behavior violates the reasonable diagnosis and treatment agreement.
(3) Facts of violation and suspected amount. After verification, the hospital has the following violations: 1.Unreasonable fees, illegal fees43944.8yuan;2.seven mismatches, 14472.63yuan; 3. violation of “Traditional Chinese Medicine Physiotherapy Standards”, and the violation fee will be 51.2 yuan;4.< span>The report form is not signed by the doctor, and the violation fee is 270 yuan;5. span>17552.84 element.
(four) The processing department, processing basis and processing result. The Qionglai Medical Insurance Department has dealt with the hospital agreement as follows: 1.rectification within a time limit,3< span> working days to complete; 2.suspend payment for one month;3.recover default (regulations) The fee is 17552.84 yuan, and the liquidated damages will be paid according to the default (regulation) amount1 times.17552.84yuan;4.interview processing;5.70 Clause 4 of Article 2: Recover the default (regulation) fee44214.8 yuan, and the default (regulation) amount will be charged2 times to pay liquidated damages88429.6 yuan; 6.Article 72, paragraph 5, stipulates: Recover the default (regulation) fee14472.63 yuan, and pay the liquidated damages according to the default (regulation) amount3 times 43417.89yuan, suspend the medical insurance agreement1month; 7.According to Article 4 of the “Supplementary Agreement for Traditional Chinese Medicine Diagnosis and Treatment Services”: recover the default (regulation) fee51.2yuan, and the default (regulation) amount span>3 times the liquidated damages153.6 element.
(5) Opinions of the processing unit. Qionglai Minhui Hospital has no opinion on the above treatment.
Second, the operation of Kangyuan Pharmacy in Yang’an Town, Qionglai City Food Placement Cases
(1) Basics involved in the case condition. Kangyuan Pharmacy in Yang’an Town, Qionglai City, designated retail pharmacy in Qionglai City. Type of institution involved: retail pharmacy, type of institution: individual industrial and commercial household.
(2) The main process of case investigation. 2022year2 month,Qianlai City Medical InsuranceThe Bureau carried out an on-site inspection of the Kangyuan Pharmacy in Yang’an Town, Qionglai City, and found that the pharmacist was not on duty during the pharmacy’s business hours; some drugs had no price tags; Problems with food placement.
(3) Facts of violation and suspected amount. After verification,the pharmacy has the following violations:1 , pharmacists are not on duty during business hours; 2, some medicines have no price tag; 3, business premises Put food inside.
(4) The department making the processing, the processing basis and process result. Qionglai Medical InsuranceBureaufor the pharmacy The agreement is processed as follows: 1.Reform within a time limit, 3working days to complete;2.< span>Interview processing;3.suspend payment for one month;4.suspend service agreement 2months;5.pay liquidated damages1000 yuan.
(five) to be processed unit comments. Kangyuan Pharmacy, Yang’an Town, Qionglai City, has no comments on the processing results.
Third. Putting food case
(1)< /span>Basic information about the case. Chengdu Shuguo Pharmacy,Qionglai City Point RetailPharmacy. Type of institution: retail pharmacy, type of institution: individual industrial and commercial households.
(2) The main process of case investigation. 2022year2 month,Qianlai City Medical InsuranceThe Bureau carried out on-site inspection of Chengdu Shuguo Pharmacy, and found the problem of food placement in the pharmacy’s business premises.
(3) Facts of violation and suspected amount. After verification, the pharmacy exists in Illegal behavior of placing food on premises.
(four) The processing department, processing basis and processing result. Qionglai Medical InsuranceBureaufor the pharmacy The agreement is processed as follows: 1.Reform within a time limit, 3working days to complete;2.< span>Interview processing;3.suspend payment for one month;4.suspend service agreement 2months.
(Five) is the opinion of the processing unit. Chengdu Shuguo Pharmacy has no comments on the processing results.
Fourth, Chengdu Huaxing Pharmacy Chain Co., Ltd. The company sold daily necessities in the Qiongtao Road Pharmacy Office of Wenjun Street Office, Qionglai City.
(1) The case involvedorganizationBasic information. Chengdu Huaxing Pharmacy Chain Co., Ltd. Qiongtao Road Pharmacy in Wenjun Street Office, Qionglai City, and designated retail pharmacy in Qionglai City. Type of institution: retail pharmacy, type of institution: individual industrial and commercial households.
(two) The main process of case investigation. Qianlai City Medical Insurance Bureau in 2021 year12month< span>20We received reports from the masses every day, and conducted a special inspection on the Qiongtao Road Pharmacy of Chengdu Huaxing Pharmacy Chain Co., Ltd., Wenjun Street, Qionglai City, and found that the pharmacy used personal accounts to swipe cards to sell Yunnan White Medicine Toothpaste Irregularities.
(3) Facts of violation and suspected amount. After verification,the pharmacy used a personal account to swipe a card to sell a Yunnan Baiyao toothpaste, and the amount involved19.8 yuan.
(4) The department making the processing, the processing basis and process result. Qionglai Medical InsuranceBureaufor the pharmacy The agreement is processed as follows: 1.Reform within a time limit, 3working days to complete;2.< span>Interview processing;3.Suspend payment for one month;4.Recover the illegal amount19.8 yuan, and pay liquidated damages according to the violation amount3 times59.4< span>Meta;5.Suspension of Service Agreement1month.
(five) to be processed unit comments. Chengdu Huaxing Pharmacy Chain Co., Ltd. Qiongtao Road Pharmacy Office of Wenjun Street, Qionglai City has no opinion on the result.
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