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我国将严查医疗机构等领域欺诈骗保行为

2018-11-21 16:01:01    新华网

新华社北京11月21日电(记者张泉)记者21日从国家医疗保障局召开的打击欺诈骗取医疗保障基金专项行动发布会上获悉,国家医保局决定在全国范围内开展专项行动“回头看”,并已下发通知进行专门部署。

“回头看”聚焦三个重点领域:对于医疗机构,重点查处诱导参保人员住院、盗刷和冒用参保人员社会保障卡、伪造医疗文书或票据、协助参保人员套取医保基金、虚记或多记医疗服务费用等行为;对于零售药店,重点查处串换药品,刷卡套取基金等行为;对于参保人员,重点查处通过票据作假骗取基金等行为。

今年9月起,国家医保局联合卫生健康委、公安部、药监局等部门,在全国范围内开展打击欺诈骗取医疗保障基金专项行动。日前,有媒体曝光了沈阳市两家医院骗取医保基金案件,“这反映出医保基金监督管理仍是医保工作的重要短板,说明各地专项行动还需要进一步加大力度。”国家医保局监管组牵头人黄华波表示。

发布会还发布了国家医保局和各地打击欺诈骗取医疗保障基金专项行动举报投诉电话。国家医保局将建立举报奖励机制,以群众举报为重点线索,结合医保智能监控、大数据分析、开展暗访等方式,精准锁定目标,严厉打击违法违规行为。

“下一步,国家医保局将全面提升医保基金监管水平。”黄华波表示,一是建立“该发现的问题没发现是失职、发现不处理是渎职”的问责机制;二是坚持“零容忍”态度,对违法违规行为,发现一起,查处一起,对医保部门工作人员内外勾结参与欺诈骗保的,绝不姑息、绝不手软;三是加快建立基金监管长效机制,加快医保监管立法,完善智能监控体系,实行部门联动。

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