仙桃市医疗保障核查中心丨织密基金监管网，共筑医保防护线
<div class="wx_rich_media_content" id="jsWxContainer"><section style='text-align: center;'><span class="wxart_image" wx-style='display:inline-block;'></span></section><section data-support="96编辑器" data-style-id="25812" style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><section style='margin-top: 10px; margin-bottom: 10px; outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><p style='box-sizing: border-box; color: rgb(34, 34, 34); letter-spacing: 0.544px; margin-right: auto; margin-bottom: -1px; margin-left: auto; outline: 0px; max-width: 100%; width: 2em; visibility: visible; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif;'><span class="wxart_image" wx-style='display:inline-block;box-sizing: border-box;vertical-align: inherit;outline: 0px;display: block;width: 100%;overflow-wrap: break-word !important;visibility: visible !important;'></span></p><section style='padding: 0.3em 0em; outline: 0px; max-width: 100%; box-sizing: border-box; border-top: 2px solid rgb(220, 0, 0); border-bottom: 2px solid rgb(220, 0, 0); visibility: visible;'><section style='padding: 0.5em 0.8em; outline: 0px; max-width: 100%; box-sizing: border-box; background-color: rgb(255, 240, 240); visibility: visible;'><section style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><section style='outline: 0px; max-width: 100%; text-indent: 2em; visibility: visible; line-height: 2em; box-sizing: border-box !important;'><span style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><span style='color: rgb(38, 38, 38);font-size: 16px;letter-spacing: 0pt;outline: 0px;max-width: 100%;visibility: visible;font-family: 微软雅黑, Microsoft YaHei;'> 医疗保障基金是人民群众的“看病钱”“救命钱”，</span><span style='outline: 0px;max-width: 100%;visibility: visible;'><span style='color: rgb(38, 38, 38);font-family: 微软雅黑, Microsoft YaHei;'><span style='font-size: 16px;letter-spacing: 2px;'>基金的安全使用关乎广大群众的切身利益，仙桃市医疗保障基金核查中心始终把维护基金安全放在心上、扛在肩上、落实在行动上。今年以来，核查中心全体人员紧紧围绕市局部署安排，对全市定点医药</span><span style='font-size: 16px;letter-spacing: 2px;'>机构开展全覆盖检查，以零容忍的态度严厉打击欺诈骗取医保基金行为，切实维护医疗保障基金安全。</span></span></span></span></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="16017" style='outline: 0px; max-width: 100%; color: rgb(34, 34, 34); letter-spacing: 0.544px; visibility: visible; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; box-sizing: border-box !important;'><section data-width="26%" style='box-sizing: border-box; margin-right: auto; margin-left: auto; outline: 0px; max-width: 100%; width: 26%; text-align: center; visibility: visible;'><br style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'></section></section><section data-support="96编辑器" data-style-id="25048" style='outline: 0px; max-width: 100%; color: rgb(34, 34, 34); letter-spacing: 0.544px; visibility: visible; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; box-sizing: border-box !important;'><section style='margin-top: 10px; margin-bottom: 10px; outline: 0px; max-width: 100%; text-align: center; letter-spacing: 2px; line-height: 1.75em; visibility: visible; box-sizing: border-box !important;'><section style='box-sizing: border-box; outline: 0px; max-width: 100%; width: 22px; display: inline-block; vertical-align: middle; visibility: visible; transform: rotate(0deg);'><span class="wxart_image" wx-style='display:inline-block;box-sizing: border-box;outline: 0px;vertical-align: middle;width: 100%;display: initial;overflow-wrap: break-word !important;visibility: visible !important;'></span></section><section style='margin-right: -29px; margin-left: -29px; padding-right: 29px; padding-left: 48px; outline: 0px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: middle; visibility: visible;'><section style='outline: 0px; max-width: 100%; box-sizing: border-box; border-bottom: 1px solid rgb(255, 155, 79); visibility: visible;'><section style='margin-right: 5px; margin-bottom: 3px; outline: 0px; max-width: 100%; border-bottom: 1px solid rgb(255, 155, 79); visibility: visible; transform: translate3d(-5px, 0px, 0px); box-sizing: border-box !important;'><section style='outline: 0px; max-width: 100%; color: rgb(255, 155, 79); letter-spacing: 1px; line-height: 30px; visibility: visible; box-sizing: border-box !important;'><p style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><span style='outline: 0px; max-width: 100%; font-size: 15px; visibility: visible; box-sizing: border-box !important;'><strong style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><span style='outline: 0px; max-width: 100%; letter-spacing: 2px; color: rgb(255, 76, 65); visibility: visible; box-sizing: border-box !important;'> <span style='outline: 0px;max-width: 100%;visibility: visible;font-size: 16px;font-family: 微软雅黑, Microsoft YaHei;'>现场突击检查</span></span></strong><span style='outline: 0px;max-width: 100%;letter-spacing: 2px;color: rgb(255, 76, 65);visibility: visible;'> </span></span></p></section></section></section></section></section></section><p style='outline: 0px; max-width: 100%; color: rgb(34, 34, 34); letter-spacing: 0.544px; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; box-sizing: border-box !important;'><br></p><section data-tools="135编辑器" data-id="120052" data-color="#c00000"><section><section><section style='padding: 25px 20px;background-color: #fafafa;margin-top: 5px;box-sizing: border-box;'><section style='line-height: 1.75em; letter-spacing: 1.5px; background: transparent;'><section data-autoskip="1"><p style='line-height: 2em;text-indent: 2em;'><span style='font-size:16px;'> 稽查人员不定时对医保定点药店突击检查。一、盘点进销存药品是否相符，核对结算单与购药小票是否一致，有无患者签名；二、检查药店是否存在兼营日用品、化妆品等与医药健康无关的商品；三、查看是否存在串换医保药品、医用耗材等违规行为。</span></p></section></section></section></section></section></section><section data-tools="135编辑器" data-id="120052" data-color="#c00000"><section><section><section><section data-width="15%"><section data-tools="135编辑器" data-id="118214"><section style='margin: 20px auto;'><section style='display: flex;justify-content: center;transform-style: preserve-3d;'><section style='box-sizing:border-box;width: 60%;transform: translateZ(5px);transform: translateZ(5px);-webkit-transform: translateZ(5px);-moz-transform: translateZ(5px);-ms-transform: translateZ(5px);-o-transform: translateZ(5px);' data-width="60%"><section style='box-sizing:border-box;max-width: 100% !important;width: 100%;' data-width="100%"><span class="wxart_image" wx-style='display:inline-block;box-sizing: border-box;vertical-align: inherit;width: 430px;display: block;height: 430px;'></span></section></section><section style='box-sizing:border-box;width: 46%;display: flex;justify-content: space-around;align-items: center;flex-direction: column;margin-left: -40px;transform: translateZ(10px);transform: translateZ(10px);-webkit-transform: translateZ(10px);-moz-transform: translateZ(10px);-ms-transform: translateZ(10px);-o-transform: translateZ(10px);' data-width="46%"><section style='padding: 4px; box-sizing: border-box;'><section style='box-sizing:border-box;max-width: 100% !important;width: 100%;' data-width="100%"><span class="wxart_image" wx-style='display:inline-block;box-sizing: border-box;vertical-align: inherit;width: 258px;display: block;height: 258px;'></span></section></section><section style='display: flex;justify-content: flex-end;'><section style='transform-style: preserve-3d;'><section style='box-sizing: border-box;width: 100%;height: 10px;background-color: rgb(255, 242, 242);margin-top: -8px;max-width: 100% !important;overflow: hidden;transform: translateZ(5px);-webkit-transform: translateZ(5px);-moz-transform: translateZ(5px);-ms-transform: translateZ(5px);-o-transform: translateZ(5px);' data-width="100%"><br></section></section></section></section></section></section></section><p><span style='font-size: 12px;color: rgb(136, 136, 136);'>△图：稽查人员随机抽查药店患者购药结算单，并拨打患者预留电话核实情况。</span></p><p style='text-align: center;'><br></p></section></section><section style='padding: 25px 20px;background-color: #fafafa;margin-top: 5px;box-sizing: border-box;'><section style='line-height: 1.75em; letter-spacing: 1.5px; background: transparent;'><section data-autoskip="1"><section style='text-indent: 2em;line-height: 2em;'><span style='font-size:16px;'> 稽查人员到医保定点医疗机构进行实地核查。一、重点核实住院病人身份、有无挂床住院、入院指征把关不严等违规行为；二、随机抽查在院病历，查有无过度检查、超限制用药、用药与实际病情不符等违规行为。规范定点医药机构诊疗服务和收费行为，确保医保基金安全、高效、合理使用。</span><span style='font-size: 16px;background-color: transparent;caret-color: red;'></span></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="25048"><section><section data-tools="135编辑器" data-id="119842" data-color="#c00000"><section style='margin: 10px auto;display: flex;align-items: flex-end;justify-content: center;transform-style: preserve-3d;'><section style='box-sizing:border-box;width: 50%;transform: translateZ(10px);transform: translateZ(10px);-webkit-transform: translateZ(10px);-moz-transform: translateZ(10px);-ms-transform: translateZ(10px);-o-transform: translateZ(10px);' data-width="50%"><section style='display: flex;justify-content: flex-start;'><section style='padding-right: 35px;padding-bottom: 20px;padding-left: 5px;box-sizing: border-box;'><section style='display: flex;align-items: center;'><section style='font-size: 20px;letter-spacing: 1.5px;color: rgb(192, 0, 0);padding-right: 5px;box-sizing: border-box;'><br><span style='color: rgb(136, 136, 136);font-size: 12px;letter-spacing: 0.544px;caret-color: red;font-family: 微软雅黑, Microsoft YaHei;'>▽图：稽查人员询问患者的住院情况，并在结算窗口核对相关信息。</span></section></section></section></section><section style='padding: 3px; box-sizing: border-box;'><section style='box-sizing:border-box;max-width: 100% !important;width: 100%;' data-width="100%"><span class="wxart_image" wx-style='display:inline-block;box-sizing: border-box;vertical-align: inherit;width: 237px;display: block;height: 309px;'></span></section></section></section><section style='box-sizing: border-box;width: 75%;margin-bottom: 30px;margin-left: -30px;transform: translateZ(5px);' data-width="75%"><section style='box-sizing:border-box;max-width: 100% !important;width: 100%;' data-width="100%"><span class="wxart_image" wx-style='display:inline-block;box-sizing: border-box;vertical-align: inherit;width: 365px;display: block;height: 475px;'></span></section></section></section></section><section data-support="96编辑器" data-style-id="16017" style='outline: 0px; max-width: 100%; color: rgb(34, 34, 34); letter-spacing: 0.544px; visibility: visible; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; box-sizing: border-box !important;'><section data-width="26%" style='margin-right: auto; margin-left: auto; box-sizing: border-box; outline: 0px; max-width: 100%; width: 150.266px; text-align: center; visibility: visible;'><br></section><section data-support="96编辑器" data-style-id="25048" style='outline: 0px; max-width: 100%; letter-spacing: 0.544px; visibility: visible; box-sizing: border-box !important;'><section style='margin-top: 10px; margin-bottom: 10px; outline: 0px; max-width: 100%; text-align: center; letter-spacing: 2px; line-height: 1.75em; visibility: visible; box-sizing: border-box !important;'><section style='box-sizing: border-box; outline: 0px; max-width: 100%; width: 22px; display: inline-block; vertical-align: middle; visibility: visible; transform: rotate(0deg);'><span class="wxart_image" wx-style='display:inline-block;vertical-align: middle;box-sizing: border-box;outline: 0px;width: 21.9886px;display: initial;overflow-wrap: break-word !important;visibility: visible !important;'></span></section><section style='margin-right: -29px; margin-left: -29px; padding-right: 29px; padding-left: 48px; outline: 0px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: middle; visibility: visible;'><section style='outline: 0px; max-width: 100%; box-sizing: border-box; border-bottom: 1px solid rgb(255, 155, 79); visibility: visible;'><section style='margin-right: 5px; margin-bottom: 3px; outline: 0px; max-width: 100%; border-bottom: 1px solid rgb(255, 155, 79); visibility: visible; transform: translate3d(-5px, 0px, 0px); box-sizing: border-box !important;'><section style='outline: 0px; max-width: 100%; color: rgb(255, 155, 79); letter-spacing: 1px; line-height: 30px; visibility: visible; box-sizing: border-box !important;'><p style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><span style='outline: 0px; max-width: 100%; font-size: 15px; visibility: visible; box-sizing: border-box !important;'><strong style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><span style='outline: 0px; max-width: 100%; letter-spacing: 2px; color: rgb(255, 76, 65); visibility: visible; box-sizing: border-box !important;'> <span style='outline: 0px;max-width: 100%;visibility: visible;font-size: 16px;font-family: 微软雅黑, Microsoft YaHei;'>大数据</span><span style='outline: 0px;max-width: 100%;visibility: visible;font-size: 16px;font-family: 微软雅黑, Microsoft YaHei;'>智能审核</span></span></strong><span style='outline: 0px;max-width: 100%;letter-spacing: 2px;color: rgb(255, 76, 65);visibility: visible;'> </span></span></p></section></section></section></section></section></section><section data-tools="135编辑器" data-id="120052" data-color="#c00000"><section><section><section><section data-width="15%"><section data-width="100%"><br></section></section></section><section style='margin-top: 5px;padding: 25px 20px;background-color: rgb(250, 250, 250);box-sizing: border-box;'><section style='line-height: 1.75em; letter-spacing: 1.5px; background: transparent;'><section data-autoskip="1"><section style='text-indent: 2em;line-height: 2em;'><span style='font-size: 16px;text-indent: 2em;background-color: transparent;'> 稽查人员运用医疗保障智能监管系统从医保结算系统中获取并实时监控分析医保诊疗和结算数据，对定点医院住院费用进行全方位、全过程智能审核监控。根据省局下发的审核规则进行数据初筛，对初筛出的问题通过严格规范的初审、反馈、复审三级审核机制后确认违规行为，智能审核系统将对违规项目发起扣款，实现住院医疗费用全过程监管。</span></section></section></section></section></section></section></section><p style='text-align: center;'><span class="wxart_image" wx-style='display:inline-block;'></span></p><p style='margin-top: 8px; margin-right: 7px; margin-left: 7px; text-indent: 0em;'><span style='letter-spacing: 0.544px; color: rgb(136, 136, 136); font-size: 12px;'>△</span><span style='letter-spacing: 0.544px; color: rgb(136, 136, 136); font-size: 12px;'>图</span><span style='letter-spacing: 0.544px; color: rgb(136, 136, 136); font-size: 12px;'>：</span><span style='letter-spacing: 0.544px; color: rgb(136, 136, 136); font-size: 12px;'>稽查人员利用湖北国家医疗保障信息平台不定期对定点医疗机构数据进行分析。</span><span style='letter-spacing: 0.544px; color: rgb(136, 136, 136); font-size: 12px;'></span></p><section data-width="26%" style='margin-right: auto; margin-left: auto; box-sizing: border-box; outline: 0px; max-width: 100%; width: 150.266px; text-align: center; visibility: visible;'><br></section></section><section data-support="96编辑器" data-style-id="25048" style='outline: 0px; max-width: 100%; color: rgb(34, 34, 34); letter-spacing: 0.544px; visibility: visible; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; box-sizing: border-box !important;'><section style='margin-top: 10px; margin-bottom: 10px; outline: 0px; max-width: 100%; text-align: center; letter-spacing: 2px; line-height: 1.75em; visibility: visible; box-sizing: border-box !important;'><section style='box-sizing: border-box; outline: 0px; max-width: 100%; width: 22px; display: inline-block; vertical-align: middle; visibility: visible; transform: rotate(0deg);'><span class="wxart_image" wx-style='display:inline-block;vertical-align: middle;box-sizing: border-box;outline: 0px;width: 22px;display: initial;overflow-wrap: break-word !important;visibility: visible !important;'></span></section><section style='margin-right: -29px; margin-left: -29px; padding-right: 29px; padding-left: 48px; outline: 0px; max-width: 100%; box-sizing: border-box; display: inline-block; vertical-align: middle; visibility: visible;'><section style='outline: 0px; max-width: 100%; box-sizing: border-box; border-bottom: 1px solid rgb(255, 155, 79); visibility: visible;'><section style='margin-right: 5px; margin-bottom: 3px; outline: 0px; max-width: 100%; border-bottom: 1px solid rgb(255, 155, 79); visibility: visible; transform: translate3d(-5px, 0px, 0px); box-sizing: border-box !important;'><section style='outline: 0px; max-width: 100%; color: rgb(255, 155, 79); letter-spacing: 1px; line-height: 30px; visibility: visible; box-sizing: border-box !important;'><p style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><span style='outline: 0px; max-width: 100%; font-size: 15px; visibility: visible; box-sizing: border-box !important;'><strong style='outline: 0px; max-width: 100%; visibility: visible; box-sizing: border-box !important;'><span style='outline: 0px; max-width: 100%; letter-spacing: 2px; color: rgb(255, 76, 65); visibility: visible; box-sizing: border-box !important;'> <span style='outline: 0px;max-width: 100%;visibility: visible;font-size: 16px;font-family: 微软雅黑, Microsoft YaHei;'>专项重点检查</span></span></strong><span style='outline: 0px;max-width: 100%;letter-spacing: 2px;color: rgb(255, 76, 65);visibility: visible;'> </span></span></p></section></section></section></section></section></section><p style='outline: 0px; max-width: 100%; color: rgb(34, 34, 34); letter-spacing: 0.544px; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; box-sizing: border-box !important;'><br></p></section></section><section data-tools="135编辑器" data-id="120052" data-color="#c00000"><section><section><section style='margin-top: 5px;padding: 25px 20px;background-color: rgb(250, 250, 250);box-sizing: border-box;'><section style='line-height: 1.75em; letter-spacing: 1.5px; background: transparent;'><section data-autoskip="1"><section style='text-indent: 2em;line-height: 2em;'><span style='background-color: transparent;caret-color: red;font-size: 16px;'> 稽查人员对医保定点医院进行专项重点检查。从医院HIS（Hospital Information System）系统中提取患者就诊费用明细清单、医保结算数据、药品耗材进销存等信息。在日常监管过程中，将传统的病案审核、现场检查方式与智能审核系统工具、大数据分析技术、结合应用。</span></section></section></section></section></section></section></section><section data-tools="135编辑器" data-id="119891" data-color="#c00000"><section data-op="division" style='margin: 10px auto;'><section style='display: flex;justify-content: space-between;'><section style='box-sizing:border-box;width: 76%;display: flex;justify-content: space-between;align-items:flex-end;' data-width="76%"><section style='box-sizing:border-box;max-width: 100% !important;width: 100%;' data-width="100%"><span class="wxart_image" wx-style='display:inline-block;box-sizing: border-box;vertical-align: inherit;width: 556px;display: block;height: 253px;'></span></section></section><section style='box-sizing:border-box;width: 24%;display: flex;justify-content: center;align-items: center;' data-width="24%"><section><section style='box-sizing: border-box; color: rgb(192, 0, 0); width: 14px; text-align: center; line-height: 1.3em;'><strong data-brushtype="text"><br></strong></section></section></section></section><section style='box-sizing: border-box;width: 100%;margin-top: 15px;max-width: 100% !important;' data-width="100%"></section></section></section><p style='outline: 0px; max-width: 100%; color: rgb(34, 34, 34); letter-spacing: 0.544px; font-family: system-ui, -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; box-sizing: border-box !important;'><span style='color: rgb(136, 136, 136);font-size: 12px;'></span><span style='color: rgb(136, 136, 136);font-size: 12px;'>△</span><span style='color: rgb(136, 136, 136);font-size: 12px;'>图</span><span style='color: rgb(136, 136, 136);font-size: 12px;'>：</span><span style='color: rgb(136, 136, 136);font-size: 12px;'>稽查人员正在对医疗机构开展专项检查</span><span style='color: rgb(136, 136, 136);font-size: 12px;'>。</span></p><section data-tools="135编辑器" data-id="119886" data-color="#c00000"><section style='margin: 10px auto;'><section style='margin-top: 20px;'><section style='display: flex;justify-content: flex-start;'><section style='flex-shrink: 0;'><section style='box-sizing: border-box;width: 7px;height: 100%;background-color: rgb(255, 14, 10);overflow: hidden;'><br></section></section><section style='font-size: 16px;color: rgb(255, 14, 10);padding-right: 5px;padding-left: 5px;letter-spacing: 1.5px;box-sizing: border-box;'><strong data-brushtype="text">仙桃医保</strong></section><section style='padding-right: 5px;padding-left: 5px;display: flex;align-items: center;box-sizing: border-box;'><section style='box-sizing: border-box;width: 7px;height: 14px;border-left: 1px solid rgb(255, 39, 36);border-right: 1px solid rgb(255, 39, 36);overflow: hidden;transform: skew(-30deg);-webkit-transform: skew(-30deg);-moz-transform: skew(-30deg);-ms-transform: skew(-30deg);-o-transform: skew(-30deg);'><br></section></section></section><section style='padding: 10px;background-color: rgb(255, 240, 240);margin-top: 10px;box-sizing: border-box;'><section data-autoskip="1" style='line-height: 1.75em; letter-spacing: 1.5px; color: rgb(192, 0, 0); background: transparent;'><p style='line-height: 2em;text-indent: 2em;'><span style='font-size: 16px;color: #262626;'> 医保基金稽查工作，一直在行动，永远在路上。仙桃市医疗保障基金核查中心将一如既往地打击各类医保违规行为，同时也将通过新技术、新手段，进一步建设完善全方位全过程的智能监管体系，在工作中守土尽责，把打击欺诈骗保、维护基金安全作为首要任务，综合运用各种监管手段，严守基金安全红线。</span></p></section></section></section></section></section><p style='line-height: 2em;'><br></p><p style='line-height: 2em;'>来源：仙桃医保</p></div><p></p>
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