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"hysteroscopy", "cervical cancer screening" and "cervical dilation" are all gynecological treatment items, but some male patients have also incurred such medical insurance expenses. some hospitals even carried out 1,674 such "weird" examinations in a year. in accordance with the unified deployment, medical insurance departments in various places have checked the big data problem clues issued by the national medical insurance bureau one by one.

what is it like for men to receive gynecological treatment?

some of them are medical institutions that switch items to defraud medical insurance.for example, the leiyang people's hospital in hengyang city, hunan province replaced the self-paid item "surcharge for surgery using high-frequency electrosurgical knife" which is not covered by medical insurance with the reimbursable item "intracavitary color doppler ultrasound examination (transvaginal)". another example is that the 331 hospital in zhuzhou city, hunan province replaced the self-paid item "painless gastroscopy anesthesia" (74 yuan/time) with the class b item "hysteroscopy anesthesia" (450 yuan/time) for reimbursement. these actions have caused a large number of male patients to incur gynecological treatment expenses. why do they do this? to defraud medical insurance!

in some cases, medical staff allowed female patients to use the qualifications of male insured persons to receive medical treatment.for example, medical staff at wang yanjun clinic in alxa league, inner mongolia autonomous region, allowed female patients to use the medical insurance voucher of their male relatives to settle the expenses after performing a "transvaginal color doppler ultrasound examination" on them. li, a male employee of the xingsha branch of a hunan livestock and poultry co., ltd., and his female relatives received gynecological treatment at yueyang central hospital in hunan province in september 2023, december 2023, and april 2024, and all related expenses were settled using li's medical insurance card.

so, when it comes to this type of problem, which medical institutions and doctors have the most violations?

table 1 medical institutions that rank high in gynecological diagnosis and treatment for men

table 2 doctors who rank high in prescribing gynecological treatment for men

in the next step, under the guidance of the national medical insurance administration, local medical insurance departments will combine local realities, learn from past experiences, and further expand the screening scope to ensure that all abnormal gender settlement issues in the region are cleared up.

the law is vast and wide, and nothing can escape it. in the face of big data, men and women can still be distinguished.