Cover News Reporter Zhao Yi

3月26日，封面新聞記者獲悉，即日起，《四川省定點醫藥機構相關人員醫保支付資格管理實施細則》開始生效，對定點醫療機構和定點零售藥店涉及醫療保障基金使用的相關人員的違法違規行為進行記分管理，根據記分情況暫停或終止相關人員的醫保支付資格和醫保費用結算等工作。

"The medical insurance fund is the life-saving money of the people. Through the establishment of a medical insurance payment qualification management system, the person responsible for the violation is managed by points, the regulatory tentacles are extended from the designated medical institutions to the specific responsible person, and the person responsible for the violation is dealt with accordingly, which highlights the accuracy of supervision and can effectively curb the abuse of medical insurance funds. According to the relevant person in charge of the Sichuan Provincial Medical Insurance Bureau, after the designated medical institution signs a service agreement with the medical security agency, its relevant personnel will be qualified to pay for medical insurance, provide medical services for the insured, and be included in the scope of medical insurance supervision.

Specifically, the relevant personnel include: designated medical institutions for the insured (including non-local medical insurance participants) to provide medical treatment, pharmacy, nursing, technical and other health professional and technical personnel who use the fund settlement, designated medical institutions responsible for medical expenses and medical insurance settlement review of relevant staff, as well as the main person in charge of the designated retail pharmacy (that is, the main person in charge of the drug business license).

For the relevant responsible personnel of the designated medical institutions that violate the law or violate the service agreement, on the basis of the administrative punishment or agreement disposition of the designated medical institution, the department that made the disposition shall determine the responsibility of the relevant responsible personnel. The medical insurance agency will score the relevant responsible personnel according to the nature of the behavior and the degree of responsibility. Demerit points are accumulated in one calendar year and automatically cleared in the next calendar year. The scores of relevant personnel are accumulated across institutions and regions, and the scoring information is linked across institutions and regions, and is used nationwide. When the demerit score reaches a certain value, the medical insurance payment qualification and cost settlement of the relevant responsible personnel shall be suspended or terminated.

If the relevant personnel take the initiative to correct the violations, eliminate the negative impact, and actively participate in the medical insurance management work of the institution, they can apply for restoration to the medical insurance agency that made the scoring results if they meet the conditions for applying for restoration.

The specific repair methods are: relevant personnel reach a certain class hour and participate in the examination by participating in the learning and training organized by the medical insurance department, and the test score reaches the standard and gets 1 points for repair; Relevant personnel participating in unannounced inspections, special inspections and other activities organized by the state and province in the current year for restoration, for each legal compliance full participation, 0 points can be accumulated for restoration, and the maximum number of points is not more than 0 points. The repair is valid for the current year. The restoration is carried out on the basis of the original demerit processing decision, in which the demerit score of 0 and below is a reduction of demerit points; If the demerit score is 0 or above and the medical insurance payment qualification is suspended or terminated, the suspension or termination period can be shortened by 0 months on the basis of the original demerit point handling decision after the restoration score reaches 0 or above.