Directing the handling of the case of taking advantage of the medical examination and treatment line for personal gain

Thanh Hoa Provincial People's Committee held an urgent meeting, directing units to clarify and promptly prevent violations in the case of taking advantage of the medical examination and treatment route for personal gain.

Taking advantage of the medical examination and treatment network, some cases with health insurance cards went to the doctor many times in 6 months, the number of patients coming to all medical examination and treatment facilities increased both inpatient and outpatient. In particular, the number of patients coming to public medical facilities increased abnormally.

The leader of Thanh Hoa Provincial People's Committee raised the issue that if the cause is related to management and supervision capacity, it must be promptly corrected. If there are signs of collusion between related parties to profit from health insurance, it must be investigated and handled according to the provisions of law.

Thanh Hoa is the province with the largest health insurance medical examination and treatment deficit in the country, at 395 billion VND.

The increase in medical examination and treatment costs has shown unusual signs, the cause of which lies in the management and supervision responsibilities of the Social Insurance and the health sector, and of health insurance cardholders. It is necessary to have drastic and prompt rectification.

Social insurance is the unit that signs the health insurance medical examination and treatment contract, representing the health insurance payers, so it must be the one responsible for managing the use of the health insurance fund according to regulations, and cannot use the excuse of lack of human resources or technology.

Therefore, the Social Insurance must strengthen supervision and management of health insurance examination and treatment, review the responsibility of health insurance examiners in places where there are violations in health insurance examination and treatment; must promptly and regularly inform facilities and individuals violating the law on health insurance.

One of the proposed solutions is to consider suspending health insurance medical examination and treatment contracts with violating units. Social Insurance must also quickly complete and put into operation an electronic management system across the province to better support the control of health insurance medical examination and treatment activities.

Provincial leaders requested the Thanh Hoa Department of Health to immediately rectify any signs of lax management of health insurance examination and treatment at medical examination and treatment facilities; strengthen professional guidance and direction for medical examination and treatment facilities, prevent the abuse of drugs and technical services in medical examination and treatment according to the motto of not reducing the benefits of insurance payers, and that any disease must be accompanied by such drugs and technical services.

Sectors such as: Police, Health Insurance, Department of Health, Provincial Inspectorate, based on assigned functions and tasks, must strengthen inspection and investigation of medical facilities with signs of violations in health insurance examination and treatment. Any violations must be handled according to the provisions of law./.

According to VOV