中新网8月17日电 近日，山西省医保局会同国家医保局对部分城市医保基金使用数据进行了大数据筛查，发现五家医院涉嫌存在欺诈骗保问题。这五家医院分别是忻州市保德县德馨医院、代县和平医院，以及朔州市应县东城医院、济民医院和夕阳红华康医院。
调查发现，保德县德馨医院存在伪造CT、X线摄影报告，伪造超声报告，以及无资质人员开展诊疗服务并伪造医生签名等问题。代县和平医院则存在本院职工虚假住院，伪造医学文书，滥用抗生素过度诊疗等问题。应县东城医院同样存在伪造医学文书，滥用抗生素过度诊疗等问题。
针对这些问题，山西省医保部门已经中止了保德县德馨医院的医保服务协议，并决定追回医保基金197.03万元；同时，对涉嫌骗保的问题已启动行政处罚程序。代县和平医院和应县东城医院则被解除医保服务协议，追回医保基金损失241.67万元，同样启动了行政处罚程序。
山西省医保局表示，将继续强化大数据筛查手段在医保基金监管中的应用，严厉打击各类欺诈骗保行为，确保医保基金的安全和有效使用。同时，也将加强对医疗机构的监管，提高医疗服务质量，保障参保人员的合法权益。
英语如下：
Title: “Five Hospitals in Shanxi Investigated for Alleged Insurance Fraud; National Medical Insurance Administration Steps In to Crack Down”
Keywords: Crackdown, Shanxi, Medical Insurance
Content:
CGTN August 17, 2023 – Recently, the Shanxi Provincial Medical Insurance Administration, in collaboration with the National Medical Insurance Administration, conducted a big data screening of the use of medical insurance fund data in some cities, and found that five hospitals were suspected of engaging in insurance fraud. The five hospitals involved are the Boda County Dexin Hospital in Xinxian City, the Heping Hospital in Dai County, as well as the Yingxian County Dongshenghui Hospital, the Jimin Hospital, and the Xiaoyanghong Huakang Hospital in Shuozhou City.
Investigations revealed that the Boda County Dexin Hospital had been involved in falsifying CT and X-ray reports, ultrasound reports, and allowing unqualified personnel to provide medical services and falsifying doctor signatures. The Heping Hospital in Dai County was found to have its staff falsely admitting patients, falsifying medical documents, and overusing antibiotics in inappropriate medical treatments. The Dongshenghui Hospital in Yingxian County also had issues with falsifying medical documents and overusing antibiotics in inappropriate treatments.
In response to these issues, the Shanxi Provincial Medical Insurance department has suspended the medical insurance service agreement of the Boda County Dexin Hospital and decided to recover medical insurance funds amounting to 1970,300 yuan; and has initiated administrative penalty procedures for the suspected insurance fraud. The Heping Hospital in Dai County and the Dongshenghui Hospital in Yingxian County were terminated from their medical insurance service agreements, with the recovery of medical insurance fund losses totaling 2,416,700 yuan, and administrative penalty procedures have also been initiated.
The Shanxi Provincial Medical Insurance Administration stated that it will continue to strengthen the application of big data screening techniques in the regulation of medical insurance fund management, severely crack down on all types of insurance fraud, and ensure the safety and effective use of medical insurance funds. At the same time, it will also enhance the regulation of medical institutions, improve service quality, and safeguard the legitimate rights and interests of insured individuals.
【来源】http://www.chinanews.com/sh/2024/08-17/10270367.shtml
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