What the hell is Fuling Pok Oi Hospital? Posting recruitment information on China Medical Talents Online every day, calling and saying it is full, liar hospital.

Documents of Fuling District Human Resources and Social Security Bureau of Chongqing Municipality

Furenshefa [2012] No.74

Chongqing Fuling district labor resources social security bureau

Bulletin on violations of medical insurance in Pok Oi Hospital

All designated medical institutions and retail pharmacies:

2065438+At the beginning of May, 2002, people visited Pok Oi Hospital to report that there were serious irregularities in the service behavior of patients in hospital. After investigation and verification, the hospital mainly has inflated the number of drugs, overcharged the cost of inspection items, and chaotic internal management, which leads to the untrue contents of inpatient medical records, and the medical insurance reimbursement records filled in are inconsistent with the reimbursement information in the medical insurance network. It is a serious violation of the relevant provisions of the Interim Measures for the Supervision and Administration of Medical Insurance Services in Chongqing (No.23 of Renshefa [2065438+02]) and the Interim Measures for the Administration of Medical Insurance Designated Medical Institutions in Fuling District of Chongqing (No.42 of Yufufa [2065438+00]).

The illegal behavior of Pok Oi Hospital has caused extremely negative influence in the whole region, and also exposed the weak links and problems existing in the daily management of the hospital. In order to draw a profound lesson from this incident, this Council decided to impose administrative and economic penalties on Pok Oi Hospital, give it to informed criticism within the scope of "two hospitals" in the whole district, and order him to make rectification within a time limit, so as to urge him to change his service attitude and improve the service quality.

It is hoped that all designated medical institutions and retail pharmacies in the whole region will take warning from others, further strengthen internal daily management, strengthen medical insurance policy learning, be familiar with medical insurance management processes, and firmly establish a sense of responsibility and service. It is necessary to strengthen communication with patients and their families, attach great importance to and promptly investigate and handle patients' demands, prevent similar situations from happening again, strive to achieve the goal of zero complaints in medical insurance management, effectively provide high-quality medical insurance services for patients, and promote the healthy and orderly development of medical insurance in our region. All units are requested to carry out a self-examination on the problems exposed by Pok Oi Hospital, and form a written report before July 3 1, and send it to our bureau, with a copy to the district medical insurance center.

This is a message for you.

Attachment: Notice of Fuling District Human Resources and Social Security Bureau of Chongqing Municipality on Handling Medical Insurance Violation in Pok Oi Hospital

20 12 July 18

Attachment:

Notice on the handling of medical insurance violations in Pok Oi Hospital

Chongqing Fuling district labor resources social security bureau

(July 20 12 18)

Pok oi hospital:

20 12 in early may, we received a report from the masses. After investigation and verification by our bureau, it is found that there are irregularities in the service behavior of patients' hospitalization reimbursement. According to the Interim Measures for the Supervision and Administration of Medical Insurance Services in Chongqing (No.23 of Renshefa [2012]) and the Interim Measures for the Administration of Medical Insurance Designated Medical Institutions in Fuling District of Chongqing (No.42 of Yufu Shefa [2010]), we hereby notify you of the decision on handling violations in your hospital as follows:

First, the fact of violation

(a) inflated the number of drugs, overcharged. First, patient Chen Mou was admitted to the hospital on April 26th, 20 12, and was discharged on the morning of May 5th. On the day of discharge, your hospital overcharged the patient for three days of treatment drugs and treatment expenses. Second, patient Wenmou was admitted to the hospital on May 1 day, and was discharged on May 5. During hospitalization, the dosage of Shuxuetong injection, cefoperazone sulbactam sodium, batroxobin and other drugs was the same as that of other patients, but the dosage charged in the patient's charge list was more than that of other patients.

(two) inflated inspection items and overcharged. First, at the beginning of Chen Mou's admission, you charged a 20-hour guardianship fee, but after her condition improved, she charged a 24-hour guardianship fee, which is untrue. Second, the patient did not do ambulatory blood pressure monitoring and ECG monitoring during his hospitalization, and your hospital charged the fee for ambulatory blood pressure monitoring and ECG monitoring for two days.

(C) internal management confusion. First, the contents of hospital medical records are untrue. The patient's medical record shows that the admission time is May 5th, and the discharge time is May 1 day, which is inconsistent. In the patient's hospitalization medical record, the temperature registration form records that he was discharged at 9 am on March 25th, but the course record shows that he was discharged at 9 am on March 26th. The discharge time in the nursing records was obviously changed from 25th to 26th, and the discharge time was inconsistent. Second, the medical insurance reimbursement record filled in by your hospital is inconsistent with the reimbursement information of the medical insurance network. The medical expenses of the remaining patients in the hospital totaled more than 2,000 yuan, and the medical expenses totaled more than 700 yuan, but the reimbursement record registered on the medical insurance was 700 yuan, and the medical insurance reimbursement was 666.28 yuan; According to the medical insurance network, the total hospitalization expenses of 700 yuan were 479.02 yuan for medical insurance reimbursement and 220.98 yuan for individuals. The reimbursement information of the three is inconsistent.

Second, decide

According to the above facts, there are irregularities in the hospitalization services of Chen Mou, Wenmou and Yumou in your hospital. Among them, Chen Mou and Wenmou involved in inflated drugs and overcharged and reimbursed the number of inspection items, and the violation was serious; I don't involve overcharge and reimbursement, but medical insurance management is chaotic, which is a general violation of discipline. According to the relevant provisions of the People's Social Development [2012] No.23 and the Fufufa [2010] No.42, we have decided to treat your hospital as follows:

(A) admonishing conversation

The leaders of the bureau in charge and the relevant personnel of the medical insurance center interviewed the main person in charge of your hospital, the dean in charge of business and the person in charge of the medical insurance office, and reported the investigation results, conclusions, handling decisions and rectification requirements of this violation.

(2) Economic punishment

1. Recover the 9299.80 yuan that has been allocated to your hospital (including: Chen Mou 637 1.09 yuan, Wenmou 2449.69 yuan and Yumou 479.02 yuan), which will be deducted from other funds that your hospital should allocate.

2. Deduct the penalty from your hospital117451.31yuan (in the hospitalization service of patients and Wenmou, the circumstances are serious, and the total reimbursement for hospitalization in your hospital in May of 20 12 is 20% per person. In the hospitalization service of a patient, illegal reimbursement is a general violation of discipline, and liquidated damages are deducted according to the equal amount of reimbursement. Be sure to deposit in the district medical insurance center within three working days.

3. Refund 84 1.59 yuan (including 536.79 yuan for Chen Mou and 304.80 yuan for Wenmou) for the medical expenses incurred by the above patients due to the inflated drug quantity in your hospital.

(three) our bureau will informed criticism this illegal act in your hospital within the scope of the "two institutes" in the whole region, and it will be included in the assessment of the year-end service agreement.

(4) rectification within a time limit. First, order your hospital to strengthen the policy and business study of medical insurance management and handling personnel (our bureau can arrange comrades familiar with policies to preach in your hospital); Second, order your hospital to rectify within a time limit from July 19/month, improve the medical insurance management system in the hospital, strengthen the medical insurance management and the responsibility of the handlers, establish the accountability system for violations, improve the workflow, change the service attitude and improve the service quality. After the expiration of the rectification period, your hospital will submit a written application for review. After the audit, our bureau will organize relevant personnel to determine whether to continue the rectification and suspend the medical insurance networking or cancel the medical insurance designated qualification according to their rectification attitude and the effect achieved.

I hereby inform you.

Keywords: medical insurance violations handling bulletin

20 12 07 18 Seal of Chongqing Fuling District Human Resources and Social Security Bureau Office

(* * * 6 copies.