某三甲医院内部加强医保基金监管举措探讨  

Discussion on Measures to Strengthen the Supervision of Medical Insurance Funds in a Tertiary A Hospital

作　　者：李景涛[1] 王建斌[1] 刘瑜 侯慧玉[1] 何其慧 王庆军[1] 陈少鹏[1] 王亚珍[1] LI Jingtao;WANG Jianbin;LIU Yu;HOU Huiyu;HE Qihui;WANG Qingjun;CHEN Shaopeng;WANG Yazhen(Medical Insurance Office of Hebei Provincial People's Hospital,Shijiazhuang,Hebei Province,050050 China)

机构地区：[1]河北省人民医院医疗保险办公室,河北石家庄050050

出　　处：《中国卫生产业》2021年第21期87-90,共4页China Health Industry

摘　　要：国家医保局成立以来,习近平总书记已经先后多次对基金监管作出了重要指示批示。2020年1月3日,习近平总书记批示“要建立和强化长效监管机制,长抓不懈”;1月13日,习近平总书记又在十九届中央纪委四次全会上强调“要坚决查处医疗机构内外勾结欺诈骗保行为,建立和强化长效监管机制”。这充分显示了中央和国家对医保基金监管工作的高度重视,对打击欺诈骗保行为的坚定决心。该文通过多重管理机制开展打击欺诈骗保,规范诊疗行为,促进医、保、患三方权益平衡。Since the establishment of the National Medical Insurance Administration,General Secretary Xi Jinping has issued important instructions on fund supervision many times.On January 3,2020,General Secretary Xi Jinping instructed“to establish and strengthen a long-term supervision mechanism,and make persistent efforts”;on January 13,General Secretary Xi Jinping emphasized at the Fourth Plenary Session of the 19th Central Commission for Discipline Inspection,“we must resolutely investigate and punish Collusion between inside and outside medical institutions to defraud insurance and insurance,establish and strengthen a long-term monitoring mechanism”.This fully shows that the central government and the state attach great importance to the supervision of medical insurance funds and are determined to fight against fraudulent insurance fraud.The articale is carried out through multiple management mechanisms to combat fraud and insurance fraud,standardize diagnosis and treatment behaviors,and promote the balance of rights and interests of the medical,insurance,and patient parties.

关 键 词：医疗保险 基金监管 欺诈骗保 

分 类 号：R19[医药卫生—卫生事业管理]