近日，国家医保局通报了一心堂药业集团的整改情况，这是该局成立以来首次对大型定点零售药店进行约谈。据了解，一心堂旗下的一些门店存在串换药品、超量开药、处方药销售不规范等问题，导致医保基金损失。对此，国家医保局基金监管司负责人徐友龙表示，约谈的目的是督促一心堂加强管理，规范行为，并履行医保基金的自我管理主体责任，以维护医保基金的安全。
徐友龙还提到，在检查中发现一心堂主要存在虚假开药、串换药品、超量开药等突出问题。虚假开药通常涉及虚构药品销售记录和处方，套取医保基金；串换药品则包括将非药品串换为医保药品等行为；超量开药则包括诱导参保人集中购药等现象。
对于药店自查自纠后是否会有第三方介入调查，徐友龙表示，除了自查自纠外，医保部门还将进行大规模的数据筛查和现场检查，对违规行为进行处理处罚。
此次约谈大型定点零售药店传递了一个明确的信息：国家医保局将对医保基金的监管更加严格，确保基金的安全使用。这不仅是对一心堂的警示，也是对所有医保定点零售药店的提醒，要严格遵守医保基金使用规定，共同维护医保基金的安全。
英语如下：
News Title: “Upgrade of Medical Insurance Fund Supervision: How to Strengthen the Supervisory Net?”
Keywords: Supervision, Medical Insurance, Tight Net
News Content: Recently, the National Medical Insurance Administration (NMIA) issued a report on the rectification status of Heng Tang Pharmaceutical Group, marking the first time it has summoned a large-scale designated retail pharmacy for dialogue since its establishment. It is understood that some stores under Heng Tang have been found to have issues such as switching medications, over-prescribing, and unstandardized sales of prescription drugs, leading to losses in the medical insurance fund. In response, Jiuyou Long, the head of the Medical Insurance Fund Supervision Division of the NMIA, stated that the purpose of the dialogue was to urge Heng Tang to strengthen management, regulate behavior, and fulfill its self-management responsibility for the medical insurance fund in order to safeguard the safety of the fund.
Jiuyou Long also mentioned that during the inspection, Heng Tang was found to have major problems such as falsifying prescriptions, switching medications, and over-prescribing. Falsifying prescriptions often involves creating false records of drug sales and prescriptions to defraud the medical insurance fund; switching medications includes exchanging non-medicines for medical insurance drugs; and over-prescribing includes inducing insured individuals to purchase drugs in bulk.
Regarding whether there will be a third-party intervention after the pharmacy conducts self-inspection and rectification, Jiuyou Long stated that in addition to self-inspection and rectification, the medical insurance department will conduct a massive data screening and on-site inspection to deal with and penalize illegal behaviors.
This dialogue with a large-scale designated retail pharmacy sends a clear message: the NMIA will strictly supervise the medical insurance fund to ensure its safe use. This is not only a warning to Heng Tang but also a reminder to all medical insurance designated retail pharmacies to strictly comply with the regulations for the use of the medical insurance fund and jointly safeguard the safety of the fund.
【来源】http://www.chinanews.com/cj/2024/08-17/10270356.shtml
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