民营医院一直是医疗行业激活经营机制、改善服务质量的一大亮点，而今却因为缺少监管而出现一些违反道德、法律的行为。今年6月以来，按照省人社厅要求，昆明市市县两级医保经办机构对14家民营医院进行了重点专项核查。昨日，昆明市医保中心召开的昆明市医疗保险定点民营医疗机构工作会议上，由昆明市医保中心公布了被核查医院普遍存在的问题及处理意见，其中医保基金欺诈行为问题可谓令人瞠目结舌。

Civilian battalion hospital medical industry has been activated management mechanism/Improving the service quality of a big luminescent spot,But now because the lack of supervision and appear some violation of morality/Legal behavior.Since June this year,According to the provincial people club hall requirements,Kunming cities and counties two stage protects agency orgnaization to 14 home civilian battalion hospital focusing on the special inspection.yesterday,Kunming medical insurance at the center of kunming medical insurance private medical institutions designated work meeting,By kunming medical center released by check hospital common problems and treatment opinions,The medical insurance fund fraud behavior problems is stunning.

　　对核查存在违规行为的14家民营医院，官方态度强硬。会上，昆明市医保中心强调，将责令14家定点医疗机构立即停止违规行为，同时追回违规费用，扣除当期服务质量保证金。共扣除违规费用423.04万元，扣除服务质量保证金270.04万元。

The identification of the existing violations of the fourteen civilian battalion hospital,The official attitude tough.meeting,Kunming medical insurance center stressed,Will nod medical establishment shall be ordered to 14 home immediately to stop illegal behavior,At the same time, recover illegal costs,Deduct current service quality margin.A total of deduction of costs 4.2304 million yuan,Deduct service quality security deposit of 2.7004 million yuan.

　　对其中13家定点医疗机构，分别给予暂停或关闭医保支付系统的处理，对违规情节较重的医院给予终止服务协议或提请行政部门取消其定点资格的处理。

The 13 home fixed-point medical institutions,, and to suspend or shut down the processing of medical insurance payment system,To illegal if the circumstances are relatively heavy hospital give terminate service agreement or the administrative department to cancel the qualification of fixed point of the treatment.

　　接下来，昆明市医保经办机构准备于2012年四季度进行昆明市医疗保险基金支付专项检查，对伪造医疗文书，编造费用结算明细，并向医保经办机构申报拨付费用，套取、诈骗医保基金等七大类违法行为进行专项核查。

The next,Kunming protects agency orgnaization preparation in 2012 fourth quarter for kunming fund of medical treatment insurance to pay special inspection,To forge medical documents,Make up cost settlement detail,And to orgnaization of agency of medical insurance expenses allocated declaration,Show the/Fraud, such as medical insurance fund seven kind of illegal conduct special inspection.

违规行为 violations

无资质者行医 No aptitude practice medicine

　　部分医院存在大量使用无资质人员为参保人提供医疗服务，或提供服务地点与注册执业资格证地点不吻合的问题。

There are many use part of the hospital without qualification personnel to join people providing medical service,Or provide services with the location of practice registration certificate site doesn't agree with problems.

极力让病人住院 Trying to let patients in hospital

　　不经门诊检查诊断、未判断是否有入院指征或降低入院指征收参保人住院，更有甚者，通过出院退返现金、发代金券、吃饭免费等手段任意减免住院费用的病人自付部分，诱导无住院指征的参保人进行疗养式住院。

Without the consent of the outpatient service inspection diagnosis/Not sure whether they are to the hospital indications or reduce admission refers to the collection of ginseng protect people in hospital,What is more,Through the discharge return to cash/Hair cash coupon/Eat free, and other means any reduction hospitalization expense patient pays part,Induced no hospital indications of ginseng protect people health type in hospital.

伪造资料套医保金 Forged material set of medical insurance gold

　　对医保药品违规加价，上传资料套取医保基金，或是虚传药品或检查费用。编造医疗文书，病历与实际诊疗内容不符合，或冒用有资质医师出具检查报告并上传费用。编造住院事实，挂床住院，在院率不达标。

Medical insurance drugs to illegal mark-ups,Upload data show the medical insurance fund,Or virtual preach drugs or checking expenses.Made up medical documents,Medical records and the actual content does not conform to the diagnosis and treatment,Or fake have aptitude medical certificate issued by the inspection report and upload cost.Fabricated facts in hospital,Hanging bed in hospital,In the court rate is below standard.

乱检查、乱用药 Random inspection/Using medicineatwill

　　违规使用医保用药，病情检查诊断和用药不吻合，或扩大检查范围进行套餐式检查，提供不合理不必要的医疗服务。

Illegal use of medical insurance drugs,Work-up diagnosis and medicine doesn't agree with,Or expand the scope of examination for package type check,Provide unreasonable unnecessary medical service.

内行揭秘 Adept revelation

为回笼资金 竟坑蒙拐骗 For the collection of receivables have KengMeng kidnap

　　一位从事医院管理多年的业内人士透露，按照相关规定，国家允许民营医院自取得执业登记证之日起，三年内给予一定的税收优惠。但事实上，因为信誉度等多种原因，许多民营医院在取得执业登记后，往往要有两年以上的运作，才能真正开始赢利。所以三年的税收优惠政策，民营医院得到的实惠并不多。因此，为了在短时间内得到回报，一些民营医院便干起坑蒙拐骗的勾当。

A engaged in hospital management many years of industry insiders revealed,According to the relevant provisions,Countries allow civilian battalion hospital has since the date of practice registration certificate,Three years offer certain preferential tax.But in fact,Because the credibility and so on the many kinds of reasons,Many private hospitals in obtained after the practice registration,Often have two years of operation,Can we truly becomes a going concern.So three years of preferential tax policy,Civilian battalion hospital get benefits is not much.therefore,In order to get return in a short time,Some civilian battalion hospital and bottom KengMeng kidnaping business.

　　这位人士表示，由于市场竞争激烈，为了资金回笼、投资收益，一些医院使出浑身解数吸引患者，尤其像启用无医生资质的员工更是为了降低成本，甚至吹嘘专家“资质”，都是常有的事情。

The people said,As the market competition is intense,In order to withdrawal of funds/Investment income,Some hospitals bend over backwards to attract patients,Especially like enable no doctor qualification staff is to reduce the cost,Even brag about experts"qualification",All is often the things.

　　昆明市医保中心工作人员介绍，昆明市即将出台的《昆明市基本医疗保险定点服务机构管理实施办法》将大大帮助医疗经办机构对违法行为等进行界定，并有了制度性的执法保障，对于那些违法行为及企业，有法可依是最好的“戒尺”。

Kunming medical insurance center staff introduced,Kunming about to publish[The basic medical insurance of kunming designated service management measures for the implementation]Will greatly help orgnaization of agency of medical treatment for illegal behavior of definition,And the institutional guarantee of law enforcement,For those illegal behavior and enterprise,Work is the best"ferule".

市民声音 Citizens voice

100元疗养10天之后 100 yuan health 10 days later

　　家住北市区的余先生今年4月被朋友邀约至海埂边一家疗养院疗养。余先生介绍，疗养院提供的服务只对持有昆明市医保卡的参保人提供，持卡人先垫付1000元，疗养时间为10天，等疗养期一过退回参保人900元，而疗养的人一进去就被拉去体检，体检完就开始住院打针吃药，住院期间不准回家探望亲人。

Live in the BeiShiOu Mr. Yu in April this year be friends invitations to such edge a nursing home health.Introduce Mr. More than,Nursing homes to provide service to hold only the ginseng of kunming medical insurance card provides,Cardholder payment first 1000 yuan,Health time for 10 days,And recuperate period a return ginseng protect people 900 yuan,And health people entered was pulled to medical examination,After medical hospital began to give or take an injection take medicine,During be in hospital are not allowed to go home to visit relatives.

　　虽然持卡人只掏了100元就住院疗养，但据昆明市医保中心工作人员介绍，通过举办这样的疗养服务，疗养机构可以在每个疗养人身上向医保基金套取4000元，此举损害了医保基金安全，更损害了医保参保人利益。(朱虹)

Although the cut only 100 yuan is in hospital health,But according to kunming medical insurance center staff introduced,Through holding such health service,Health institutions may, in each health person to show the medical insurance fund 4000 yuan,It harm the safety of medical insurance fund,More harm the interests of medical insurance protects a person.(ZhuHong)