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>>政策文件

关于建立打击欺诈骗取医疗保障基金长效机制的通知

2019-05-17 10:00 字号:【 打印本页

ag注册GEXIANSHIQUYILIAOBAOZHANGJU、WEISHENGJIANKANGJU、GONGANJU、SHICHANGJIANDUGUANLIJU:

为切实加强医疗保障基金监管,整顿医疗保障运行秩序,规范医保就医诊疗行为,加快推进打击欺诈骗取医疗保障基金工作常态化、制度化、持久化,促进医保诚信体系建设,实现医保基金安全完整,现就持续做好医疗保障基金监管工作通知如下。

一、提高站位,明确工作目标

ag注册YILIAOBAOZHANGJIJINSHILAOBAIXINGDEJIUMINGQIAN。DANGZHONGYANG、GUOWUYUANLINGDAODUOCIZUOCHUZHONGYAOZHISHI,YAOJIAQIANGYIBAOJIJINJIANGUAN,WUSHIYIBAOJIJINCHENGWEIXINDE“TANGSENGROU”,RENYOUPIANQU,YAOYIFAYANSUCHACHUGEZHONGPIANQUYIBAOJIJINXINGWEI。SHIXIANLIANGJIYILIAOBAOZHANG、WEISHENGJIANKANG、GONGAN、SHICHANGJIANDUGUANLIBUMENYAOCHONGFENRENSHIYIBAOJIJINJIANGUANGONGZUODEZHONGYAOXING、JINPOXINGHEJIANJUXING,BAJIAQIANGYIBAOJIJINJIANGUANGONGZUOZUOWEIDANGQIANHEJINHOUYIGESHIQIYIBAOGONGZUODESHOUYAORENWUHEZHONGZHONGZHIZHONG,QIANGHUAZERENDANDANG,SHIZHONGBAOCHIDAJIQIZHAPIANBAOXINGWEIDEGAOYATAISHI。YAOJUJIAOYILIAOBAOZHANGLINGYUWEIFAWEIGUIHEQIZHAPIANBAOXINGWEI,YIXIEYIGUANLIYILIAO(HU)JIGOU、LINGSHOUYAODIAN、GONGZUORENYUANHECANBAORENYUANWEIZHUYAOJIANGUANDUIXIANG,YIZHUYUAN、MENZHENJIUYIHELINGSHOUYAODIANGOUYAO、YIDIYILIAOFUWUHEFEIYONGWEIZHUYAOJIANCHANEIRONG,JIADADUIPIANQUYIBAOJIJINXINGWEIDEFANQIZHALIDU,DADAOXUANCHUANFAGUI、QIANGHUAGUANLI、JINGHUAHUANJING、ZHENSHEFANZUIDEMUDE。TONGSHIZENGQIANGYIHUANSHUANGFANGZUNSHOUYILIAOBAOZHANGGUANLIGUIDINGHELVXINGFUWUXIEYIDEZHUDONGXINGHEZIJUEXING,JINYIBUWANSHANYILIAOBAOZHANGZHILITIXI,SHIXIANYUANTOUFANGFAN,BAOZHANGYIBAOJIJINANQUAN,RANGDANGWEI、ZHENGFUFANGXIN,RANGRENMINQUNZHONGMANYI。

ER、ZHONGDIANGONGZUONEIRONG

(YI)ZHONGDIANJIANDUJICHANEIRONG

1、YILIAO(HU)JIGOU。TONGGUOXUJIAXUANCHUAN、YICHATIDENGMINGMUYOUDAO、PIANQUCANBAORENYUANZHUYUANXINGWEI;LIUCUN、DAOSHUA、MAOYONGCANBAORENYUANSHEHUIBAOZHANGKAXINGWEI;RENZHENGBUFU、EYIGUACHUANGZHUYUAN、XUGOUYILIAOFUWU、WEIZAOYILIAOWENSHUHUOPIAOJUXINGWEI;XIEZHUCANBAORENYUANKAIJUYAOPINYONGYUBIANXIAN、TAOQUYIBAOJIJINXINGWEI;XUJI、DUOJIYAOPIN、ZHENLIAOXIANGMU、YIYONGHAOCAI、YILIAOFUWUSHESHIFEIYONGXINGWEI;CHUANHUANYAOPIN、QIXIE、ZHENLIAOXIANGMUXINGWEI;FENJIESHOUFEI、CHAOBIAOZHUNSHOUFEI、ZHONGFUSHOUFEI、TAOYONGXIANGMUSHOUFEIXINGWEI;BUHELIZHENLIAOHEQITAWEIFAWEIJIJIQIZHAPIANBAODENGXINGWEI。

ag注册2、LINGSHOUYAODIAN。LINGSHOUYAODIANYAOPINDEJINXIAOCUNTAIZHANG,SHIFOUCUNZAICHUANHUANYAOPIN、WUPIN,SHUASHEBAOKAGOUMAIFEIYIBAOYONGPINHETAOXIANDENGTAOQUYIBAOJIJINDEXINGWEI。

3、CANBAORENYUAN。YIDIJIUYISHOUGONGBAOXIAO、JIUZHENPINCIJIAODUO、SHIYONGYIBAOJIJINJIAODUODECANBAORENYUANJIUYIGOUYAOXINGWEI。YISHIFUCHADAEYILIAOFEIYONGPIAOJU。DANCIZHUYUANYILIAOFEIYONGCHAOGUO5WANYUANDEPIAOJUQUANMIANFUCHA,JIEHEZHINENGJIANKONGSHUJU,5WANYUANYIXIAPIAOJUCHOUYANGFUCHA;DUIFANFUQINGZHENGZHUYUANBINGREN,CHOUCHAYIDUANSHIJIANNEIZHUYUANBINGLI,DUIBIQIANHOUBINGSHI、JIANCHA、HUAYANZILIAODEYIZHIXING。ERSHIFUCHAGUOGAOMENZHENFEIYONGDEZHENSHIXING。GEXIANSHIQUDUIMENZHENFEIYONGPAIMINGQIAN100WEIDECANBAORENYUANJINXINGQUANMIANFUCHA。JIEHEZHINENGJIANKONGXITONG,DUIQITACANBAORENYUANJIUYIXINGWEICHOUYANGFUCHA。

ag注册(ER)JIANLIJIANQUANJIJINJIANDUJIANCHAZHIDU。YISHISHIXIANLIANGJIYILIAOBAOZHANGBUMENYAOYANGEANZHAOGUIDING,QIANGHUAYUYIYAO(HU)JIGOUJINXINGXIEYIGUANLI,DUISHENQINGXIEYIGUANLIDEYIYAO(HU)JIGOU,YAOYANGEANZHAOGUIDINGDECHENGXUHEBIAOZHUNJINXINGPINGGU,NARUYIBAOGUANLIDEYIYAOJIGOUYAOQUANBUQIANDING《FUWUXIEYI》,YAOJIANLIDUIQIANYUEYIYAO(HU)JIGOUTIGONGHEFASHENGDEFUWUXINGWEI、YILIAOFEIYONG、YILIAOWENSHUYIJIQITAXIANGGUANSHUJUZHIBIAODENGNEIRONGJINXINGJIANDUDEJICHAZHIDU。YISHIXIANSHIQUYAOXINGCHENGRI、ZHOUCHIXUBUJIANDUANDERICHANGJIANDUJICHA,YUE、JIBUDINGQIDEJIZHONGCHOUCHA,SHIJUDINGQIZUZHIKAIZHANJIZHONGJICHAYUBUDINGQILIANHEJIAOCHAJICHAXIANGJIEHEDEJIANDUJICHAZHIDU;ERSHIGEXIANSHIQUYAODUISHANGJIJIAOBAN、ZISHENSHOULI、YOUGUANBUMENZHUANJIAO、YIDIXIEBANDENGTOUSUJUBAOXIANSUO,JIANLIYOUZHENDUIXINGDEDIAOCHACHULIJIZHI;SANSHIDUIFAXIANDEQINGXIANGXINGWENTI、YUQINGFANYINGJIZHONGDEHUOQITAKENENGYINGXIANGJIAODADEWENTIJIANLIZHUANXIANGDIAOCHAJIZHI;SISHIYAOQUANMIANJIANLISUIJIDINGSHIJIAN、SUIJIDINGJIGOUDEFEIXINGJIANCHAZHIDU;WUSHIGULITANSUOKAIZHANDISANFANGJIANDUJICHASHIDIANGONGZUOJIZHI。TONGGUORICHANGJIANDUJICHAYUZHUANXIANGDIAOCHAXIANGJIEHE,DINGQIJICHAYUFEIXINGJIANCHAXIANGJIEHE,MINGCHAYUANFANGXIANGJIEHEDENGBUTONGFANGSHI,CHIXUJIADADUIQIZHAPIANQUYIBAOJIJINXINGWEIDEDAJILIDU,DUIXIAQUNEIXIEYIGUANLIDEYIYAO(HU)JIGOUHECANBAORENYUANSHIXINGJIANDUWUSIJIAO,SHIZHONGBAOCHIDAJIQIZHAPIANBAOXINGWEIDEGAOYATAISHI。

ag注册(SAN)JIANLIGAOSUZHIZHUANYEHUAJIJINJIANDUDUIWU。QIZHAPIANQUYIBAOJIJINYINBIXINGQIANG,CHACHUNANDUDA,YILIAOFUWUDETESHUXINGJIJIANDUGUANLIBUMENTICHULEGENGGAO、GENGZHUANYEDEYAOQIU。GEXIANSHIQUYAOZHUDONGSHIYINGGONGZUOXUYAO,JIAQIANGYIBAOJIJINJIANDUGUANLIDUIWUJIANSHE,YOUHUAYIXUE、YAOXUE、HULIXUE、SHENJIHEJISUANJIDENGZHUANYERENYUANPEIBEI,JINYIBUTISHENGJIJINJIANDUGUANLIRENYUANSHULIANGHEZHILIANG,CHONGSHIQUANSHIYILIAOBAOZHANGJIJINJICHAZHUANJIAKU,JIANLIYIZHIZHENGZHISUZHIGAO、YEWUNENGLIQIANGDEZHUANYEHUAJIANDUDUIWU。

ag注册(SI)TUIJINJIJINZHINENGJIANKONGXINXIHUAJIANSHE。QUANMIANQIYONGYIBAOZHINENGJIESUANPINGTAI,DUIJIEXIEYIGUANLIDANWEIDEHIS XITONGHEJINXIAOCUNXITONG,SHISHIDIAOQUHEJIANKONGBINGANagZHUCEXIANGGUANXINXI、MENZHENCHUFANGHEJINXIAOCUNDENGXIANGGUANSHUJU。QUANMIANTUIGUANGYILIAOFEIYONGXIANSHANGZHINENGSHENHE,SHIXIANLIANGJIYIBAOBUMENJUNYAOCHENGLIYIBAOZHINENGSHENHEFENXIXIAOZU,QUEDINGYIBAOSHUJUJIANKONGFENXIFANGXIANG,WANSHANJIANKONGGUIZE,XIHUAJIANKONGZHIBIAO,CHONGSHIJIANKONGZHISHIKU,SHIXIANYIBAOFEIYONGJIESUANCONGBUFENSHENHEXIANGQUANMIANSHENHEZHUANBIAN,CONGSHIHOUJIUZHENGXIANGSHIQIANTISHI、SHIZHONGJIANKONGYUJINGZHUANBIAN。

ag注册(WU)JIANLIYILIAOXINYONGTIXI。JIANLIYIYAO(HU)JIGOUJIQIFADINGDAIBIAOREN、YIBAOYISHIJIQITACONGYERENYUANHECANBAORENYUANXINYONGHEIMINGDANZHIDU。TONGGUOGUIFANYIYAO(HU)JIGOUHEYIBAOYISHIJIQITACONGYERENYUANDEYILIAOXINGWEI,YINDAOJIGOU、CONGYERENYUANHECANBAORENYUANKESHOUCHENGXIN、GUIFANXINGWEI,BUDUANTIGAOFALVYISHI、YEWUSUZHI、FUWUZHILIANGHEFUWUSHUIPING,TIGAOYILIAOJIGOUHECONGYERENYUANLVXING《FUWUXIEYI》DEZIJUEXINGHEZHUDONGXING,DUIWEIFAWEIGUIDEYIYAO(HU)JIGOUJIQIFADINGDAIBIAOREN、YIBAOYISHIJIQITACONGYERENYUANHECANBAORENYUAN,YAOANZHAO《FUWUXIEYI》DEYUEDINGHEXIANGGUANGUIDINGYIFAYIGUICHULI;DUISHOUDUANELIEHUOJINEJUDADEPIANBAOXINGWEIFUYOUZHIJIEZERENDEQIYEFARENHEZERENRENMINGDAN,YAOTUISONGZHISHIJIGONGGONGXINYONGXINXIPINGTAI,ZAIQUANSHIFANWEINEIKAIZHANLIANHECHENGJIE,QIESHIGOUZHU“YICHUSHIXIN、CHUCHUSHOUXIAN”DEXINYONGJIANGUANGEJU。

ag注册(LIU)CHANGTONGQUNZHONGJUBAOTOUSUQUDAO。SHIXIANYIBAOBUMENYAOSHELI、GONGBUWEIFAWEIJIJUBAOTOUSUDIANHUA,GONGZUOSHIJIANYAOYOUZHUANRENJIETING,JISHISHOUJIGEFANGXIANSUO,HUIYINGCHULIGELEIWENTI;GULISHIMINGJUBAO,ANYAOQIUJIANLITOUSUJUBAOJIANGLIJIZHI,JIANLIJUBAOTOUSUBAOMIZHIDU,YIFAYIGUIBAOHUJUBAORENDEGERENXINXIBUXIELU,BAOZHANGJUBAORENDEHEFAQUANYI。

(QI)JIADACONGYANCHENGJIELIDU。GEJIJINGBANJIGOUZAIRICHANGJIANDUJICHA、ZHUANXIANGDIAOCHA、FEIXINGJIANCHASHIFAXIANDEWENTIXIANSUO,YAOJINKUAILIANDIAOCHA,YIJINGCHASHI,YAOZONGHEYUNYONGXIEYIGUANLIHEXINGZHENGCHUFASHOUDUAN,YANSUZHUIJIUZEREN。YIJUXIEYIJIYUYUETAN、XIANQIZHENGGAI、ZANTINGJIESUAN、JUFUFEIYONG、ZANTINGXIEYI、JIECHUXIEYIDENGCHUFA,BINGYIFAJIYUPIANQUJINEERBEIYISHANGWUBEIYIXIAFAKUANDEXINGZHENGCHUFA。XIANSHIQUJIECHUFUWUXIEYIDEYIYAO(HU)JIGOU,YAOSHANGBAOSHIYIBAOZHONGXINBEIAN。BEIJIECHUFUWUXIEYIHUOXIEYIYOUXIAOQINEILEIJI3CIBEIZANTINGXIEYI、ZANTINGXIEYIQIJIANWEIANSHIXIANYAOQIUZHENGGAIHUOZHENGGAIBUDAOWEIDEYIYAO(HU)JIGOU,SANNIANNEIBUDEZAICISHENQINGYIBAODINGDIAN;ZHIJIEZERENRENYUANYOUZHIYEZIGEDE,ZHUGUANBUMENYIFADIAOXIAOQIZHIYEZIGE;DUICHASHIJUYOUPIANQUYIBAOJIJINDENGWEIGUIXINGWEIHUOFUYOUZERENDEYIBAOYISHI,SHIQINGJIEYANZHONGCHENGDUJIYUTINGZHIYIZHIWUNIANYIBAOJIESUANZIGEDECHULI,BINGJIANGWEIGUIXINGWEITONGBAOWEISHENGJIANKANGBUMEN;DUIJUYOUPIANQUYIBAOJIJINXINGWEIDECANBAORENYUAN,JIYUZANTINGYIBAOZHIJIEJIESUANCHULI。DUICHASHIDEWEIFAWEIGUIXIANSUO,JISHITONGBAOXIANGGUANBUMEN,YOUXIANGGUANBUMENANGUIDINGZUOCHUXINGZHENGCHULIHUOZHUIJIUDANGJIZHENGJIZEREN;DUISHEXIANFANZUIDE,JISHIYISONGSIFAJIGUAN,YIFAZHUIJIUXINGSHIZEREN。

SAN、BAOZHANGCUOSHI

ag注册(YI)JIAQIANGZUZHILINGDAO。YILIAOBAOZHANG、WEISHENGJIANKANG、GONGAN、SHICHANGJIANDUGUANLIBUMENYAOGAODUZHONGSHIDAJIQIZHAPIANQUYILIAOBAOZHANGJIJINGONGZUO,SHIXIANLIANGJIDOUYAOCHENGLIXIANGYINGDEGONGZUOLINGDAOXIAOZU,MINGQUERENYUANZUCHENGHERENWUMUBIAO,XIAOZUBANGONGSHISHEZAIYILIAOBAOZHANGJU,FUZERICHANGJIANDUJICHA、TOUSUJUBAOXIANSUOCHACHU、ZHUANXIANGDIAOCHAHEFEIXINGJIANCHADEZUZHIGONGZUO。

ag注册(ER)XINGCHENGGONGZUOHELI。YIBAOBUMENYAOQIESHIFAHUIHAOQIANTOUZUZHIXIEDIAOZUOYONG,FUZEDUIXIEYIGUANLIYILIAOJIGOUHELINGSHOUYAODIANFUWUXINGWEIHECANBAORENYUANJIUYIGOUYAOXINGWEIDEJIANDUJICHA、KUASHENGPIAOJUDEHECHA、DUIJIANDUJIANCHAZHONGFAXIANDEWEIFANFUWUXIEYIDEXINGWEISHISHIXIEYICHULI、XINGZHENGCHUFA,DUISHEXIANWEIFAWEIJIDE,SHIQINGXINGFENBIEYISONGGONGANJIGUANHUOJIWEIJIANCHAWEICHULI。

WEISHENGJIANKANGBUMENCANYUDUIXIEYIGUANLIYILIAOJIGOUYILIAOXINGWEIDEJIANDUJICHA,DUIJIANDUJICHAZHONGFAXIANDEWEIGUIYILIAOJIGOU、WEIGUIYIWURENYUANYIFAYIGUIJINXINGCHULI。

GONGANBUMENCANYUTOUSUJUBAOANJIAN(XIANSUO)DECHACHU、YUQINGFANYINGJIZHONGWENTIDEDIAOCHAHEFEIXINGJIANCHA。BANLIYIBAOLINGYUFASHENGDEYIFAYOUGONGANJIGUANGUANXIADEXINGSHIANJIAN,HUITONGXIANGGUANBUMENJIAQIANGYIBAOLINGYUXINGZHENGZHIFAYUXINGSHISIFADEXIANJIE。

SHICHANGJIANDUGUANLIBUMENCANYUDUIDINGDIANLINGSHOUYAODIANDEJIANDUJICHA。

GEBUMENYAOXIANGHUZHICHI,MIQIEHEZUO,HUTONGXINXI,PEIHELIANDONG,TONGSHICHONGFENFAHUISHANGYEBAOXIANGONGSIDISANFANGJICHADEZUOYONG,XINGCHENGGONGZUOHELI,GONGTONGTUIJINDAJIQIZHAPIANQUYIBAOJIJINXINGDONGLUODAOSHICHU,QUDESHIXIAO。

ag注册(SAN)YINGZAOYULUNFENWEI。LIYONGHAOCHUANTONGMEITIHEXINMEITI,JIAQIANGYIBAOXIANGGUANFALVFAGUIHEZHENGCEDEXUANCHUANLIDU。JIAQIANGJINGSHIJIAOYU,MIANXIANGQUANSHEHUIJIZHONGXUANCHUANYIPIQIZHAPIANBAODIANXINGANLI,YINDAOCANBAORENYUANZIJUEDIZHI、JIJIJUBAOQIZHAPIANBAOXINGWEI,QIESHIBAOZHANGYIBAOJIJINYUNXINGANQUAN。

ag注册(SI)QIANGHUAZERENZHUIJIU。XIANSHIQUYIBAOBUMENYINGQIESHILVXINGDUIXIAQUNEIXIEYIGUANLIYIYAO(HU)JIGOUDEJIANDUGUANLIZEREN,ZUOWEIJIANGUANHEDAJIQIZHAPIANQUYILIAOBAOZHANGJIJINXINGWEIDEDIYIZERENREN,DUIXIAQUNEIXIEYIGUANLIDEYIYAO(HU)JIGOUYAOZUODAOSHISHIQUANFUGAIJIANGUAN,YAOQIESHIZUODAOYOUBAOBICHA、CHABIYOUGUO,DUIYINJIANGUANBUDAOWEIDAOZHIYIBAOJIJINBEIQIZHAPIANQUDE,HUODUISHOULIDETOUSUJUBAOXIANSUOJINXINGTUOYAN、TUIWEI、DIAOCHABUDAOWEIBUCHEDIYIJIZHENGGAI、CHULI、ZHUIZEBUDAOWEIDE,JIANGJINXINGWENZE。

ag注册(WU)JIANLIDIAODUTONGBAOZHIDU。XIANSHIQUYAOZHIDINGJUTIDERICHANGJIANDUJICHAGONGZUOSHISHIFANGAN,JIANDUJICHAGONGZUOQINGKUANGYAOYOUZHUANRENANYUESHANGBAOSHIYILIAOBAOZHANGJU。DUIRICHANGJIANDUJICHABUDAOWEI、WEIZAIGUIDINGSHIXIAONEIBANJIESHANGJIJIAOBANANJIAN(XIANSUO)HUODIAOCHACHULIBUDAOWEIDE、YUQINGFANYINGJIZHONGYINGXIANGJIAODADEWENTIWEIJISHIDIAOCHACHULIDE、WEIKAIZHANFEIXINGJIANCHADENGQINGKUANGDE,SHIJUJIANGDINGQIJINXINGTONGBAO。

责任编辑:医保局
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