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car-to-car transfers induce insured persons to be hospitalized for insurance fraud, excessive diagnosis and treatment, ineffective diagnosis and treatment, fictitious diagnosis and treatment services, unqualified personnel practicing medicine without a license, and forging doctors’ signatures to issue prescriptions... xinjiang urumqi municipal medical security bureau strictly investigates and punishes them with a "zero tolerance" attitude various violations of laws and regulations in the use of medical insurance funds to ensure the safe operation of medical insurance funds. on october 3, the bureau exposed five typical cases of illegal use of medical insurance funds:

1. urumqi friendship hospital of traditional chinese medicine.after investigation, first, it was suspected of inducing insured persons to be hospitalized to defraud insurance. the hospital provides pick-up and drop-off services to some insured persons, inducing them to be hospitalized without or with low indications. the second is false upload charges. "ordinary acupuncture" is prescribed once a day, but the actual charges will be settled by medical insurance based on the number of two or more times a day. the third is over-diagnosis and ineffective diagnosis and treatment. there were 29 insured persons in the hospital who were hospitalized repeatedly in a short period of time. some inpatients were hospitalized multiple times in a short period of time and underwent "digital photography" to repeatedly examine the same part, and the inspection results showed no change in the image.

the medical insurance department recovered the illegal medical insurance fund of 208,115.11 yuan in accordance with the law and regulations, and suspended the medical insurance service agreement of the hospital. other violations of laws and regulations will be dealt with seriously in accordance with the law and regulations after verification.

2. affiliated hospital of urumqi pharmaceutical group.after investigation, it was found that the first was suspected of fictitious diagnosis and treatment services. the hospital uploaded charges for traditional chinese medicine packet treatment (large), traditional chinese medicine packet treatment (extra large), and traditional chinese medicine application treatment (>10% of the whole body surface area), but it did not actually provide patients with corresponding treatments. the second is fictitious inspection items. when the hospital uses a transcranial magnetic cerebral reflexology electrotherapy instrument for treatment, it also charges additional fees for nine treatment items including local electric massage, electroencephalogram therapy, and cerebral reflexology therapy. the actual instrument does not have corresponding treatment functions. third, there are irregularities such as excessive inspection, decomposition of charges, exchange of charges, and repeated charges.

the medical insurance department will suspend the medical insurance service agreement in accordance with the law and regulations, and other violations of laws and regulations will be dealt with seriously in accordance with the law and regulations after verification.

3. fan shuxin traditional chinese and western medicine clinic in urumqi high-tech zone (new urban district).after investigation, it was found that the charges for medical treatment items were interchanged. substitute chinese herbal medicine or western medicine into chinese medicine physiotherapy items for uploading and charging. the second is chaotic management. the management of purchase, sale and inventory is chaotic, there is no record of the entry and exit of medicines, and there is no registration book for traditional chinese medicine physical therapy. the third is to refuse inspection by the medical insurance department and fail to provide the materials required for supervision and inspection in a timely manner.

the medical insurance department will suspend the medical insurance service agreement in accordance with the law and regulations, and other violations of laws and regulations will be dealt with seriously in accordance with the law and regulations after verification.

4. nanwan street north community health service station of the nanwan district management committee of tianshan district, urumqi city.after investigation, it was found that the charges for medical treatment items were interchanged. this site does not have sand therapy facilities, so the salt therapy items are exchanged for sand therapy items for uploading and charging. the second is suspected of unqualified personnel practicing medicine without a license. the 18 people who carry out treatment projects at this station all have no medical background or qualifications. they illegally carry out traditional chinese medicine physical therapy projects such as "finger acupuncture" and "cupping therapy" and upload charges.

the medical insurance department recovered the illegal medical insurance fund of 1,419,825.54 yuan and suspended the medical insurance service agreement in accordance with laws and regulations.

5. nanliangpo community health service station of yashan area management committee, sayibak district.after investigation, it was found that the first was forgery of medical documents. personnel without medical qualifications at this station forged doctors' signatures to issue prescriptions, and carried out tcm treatment projects such as acupoint application treatment and massage treatment for cervical spondylosis. the second is to include medical expenses that are not within the scope of medical insurance payment into the settlement of medical insurance funds. the site exchanged the self-paid items of "spinal nerve block" and "knee joint nerve block" into "massage treatment for frozen shoulder" and "acupoint application treatment" for uploading and charging. third, there are problems such as excessive charges and repeated charges.

the medical insurance department recovered the illegal medical insurance fund of 480,803.87 yuan in accordance with the law and regulations, and suspended the medical insurance service agreement. after other violations of laws and regulations are verified, they will be dealt with seriously in accordance with the law and regulations.