国务院办公厅日前印发《关于推进医疗保障基金监管制度体系改革的指导意见》。《意见》要求,到2025年,基本建成医保基金监管制度体系和执法体系。要推进监管制度体系改革,建立智能监控、举报奖励、信用管理制度,完善社会监督制度。
The General Office of the State Council has recently released a guideline, stressing the reform of the supervision system for the healthcare security fund. The supervision and law enforcement systems for the fund will be basically in place by the year 2025, read the document. Urging the promotion of reform, it requires building the systems for smart supervision, tip-off rewards and credit management, and improving the system for public supervision.
上海市胸科医院,一名患者正在取药。医疗保障基金是人民群众的“看病钱”、“救命钱”,基本医疗保障制度建立以来,覆盖范围不断扩大、保障水平逐步提升,对维护人民健康权益、缓解因病致贫、推动医药卫生体制改革发挥了积极的作用。但是,受监管制度体系不健全、激励约束机制不完善等因素制约,医保基金使用效率不高,基金监管形势较为严峻。医保检查中,“挂床”、超范围经营、小病大治、过度检查用药、套高收费、分解收费、串换收费等欺诈骗保手段层出不穷。2018年国家医保局成立后,持续开展打击欺诈骗取医疗保障基金专项治理活动,对企图违法违规的现象起到了一定震慑作用。
此次出台的《关于推进医疗保障基金监管制度体系改革的指导意见》,明确加快推进医保基金监管制度体系改革,构建全领域、全流程的基金安全防控机制,严厉打击欺诈骗保行为。按照《意见》,完善基金监管体系,一方面明确监管权责清单,一方面推进监管制度体系改革,同时,制定医疗保障基金使用监督管理条例及其配套办法,强化医保基金监管法治及规范保障,加大对欺诈骗保行为的惩处力度。《意见》的印发和实施,意味着我国医保基金监管手段走向综合化、科学化,未来将逐步形成专业化、智能化、法治化的监管局面。
【重要讲话】
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。
Efforts are needed to investigate and punish insurance fraud in medical institutions, establish and strengthen a long-term supervision mechanism for the healthcare security fund.
——2020年1月13日,习近平在十九届中央纪委四次全会上发表重要讲话
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