乐清市医疗保障局乐清市公安局乐清市卫生健康局关于印发《乐清市进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞣桨浮返耐ㄖ?/title> <meta name='Maketime' content='2022-01-29 09:44:09_193'> <META HTTP-EQUIV='pragma' CONTENT='no-cache'> <META HTTP-EQUIV='Cache-Control' CONTENT='no-store, must-revalidate'> <meta name="SiteName" content="乐清市人民政府"> <meta name="SiteDomain" content="www.taoyidie.com"> <meta name="SiteIDCode" content="3303820001"> <meta name="Image" content=""> <meta name="ColumnName" content="部门文件"> <meta name="ColumnType" content="政务公开"> <meta name="ArticleTitle" content="乐清市医疗保障局乐清市公安局乐清市卫生健康局关于印发《乐清市进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞣桨浮返耐ㄖ?> <meta name="PubDate" content="2022-01-29 09:39"> <meta name="author" content=""> <meta name="description" content=""> <meta name="keywords" content=""> <meta name="ContentSource" content="市医疗保障局"> <meta name="url" content="http://www.taoyidie.com/art/2022/1/29/art_1229145291_1997092.html"> <meta name="category" content=""> <meta name="language" content="中文"> <meta name="location" content=""> <meta name="department" content=""> <meta name="guid" content="20221997092"> <meta name="effectiveTime" content="0"> <meta name="level" content="0"> <meta name="serviceCategory" content=""> <meta name="serviceObject" content=""> <meta name="comments" content=""> <meta name="subject" content=""> <script src="/script/0/2103301616554961.js"></script>  <style type="text/css"> .w1200 {width: 1200px;margin: 0 auto;} ul,li {list-style: none;} a {text-decoration: none;} .location {font-size: 14px;color: #666666;width: 1200px;margin: 20px auto;} .fa1 {overflow: hidden;margin: 0 auto;margin-bottom: 40px;line-height: 30px;} </style> <script type="text/javascript"> waphead(); 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</script><style type="text/css"> .wapdetail table{table-layout: fixed;} .wh li { border-right: 1px solid #e6edf3; border-bottom: 1px solid #e6edf3; float: left; height: 48px; line-height: 48px; } .bh { height: 30px; font-size: 15px; line-height: 30px; width: 100%; text-align: right; font-weight: 700; color: #000; margin: 0 auto; margin-top: 20px; } </style> <script type="text/javascript"> function ChangeColor(ColorName) { document.getElementById("c").style.background = ColorName; } </script> <script language="javascript"> function doZoom(size) { document.getElementById('zoom').style.fontSize = size + 'px'; } </script> <div class="wapdetail"> <table style="width:100%;" border="0" align='center' cellpadding="0" cellspacing="1" id="c"> <tr> <td colspan="2" align='center' class="title" style="font-size:28px;font-weight:bold;color:#db140c;line-height: 70px;"> <div class="showtit" style="width:750px;height:auto;line-height:41px;margin:20px 0;"> 乐清市医疗保障局乐清市公安局乐清市卫生健康局关于印发《乐清市进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞣桨浮返耐ㄖ? </div> </td> </tr> <tr> <td colspan="2" align="center"> <ul width="100%" align="center" style="font-size:14px;font-weight:bold;color:#888;margin: 0 30px;padding: 0;overflow: hidden;border-left: 1px solid #e6edf3;border-top: 1px solid #e6edf3;" class="wh"> <li style="background:#f8f9fb;text-align:right;width:130px;padding-right:20px;">索引号：</li> <li style="width:386px;padding-left:20px;"> 11330382MB1645783U/2022-201784 </li> <li style="background:#f8f9fb;text-align:right;width:130px;padding-right:20px;">主题分类：</li> <li style="width:386px;padding-left:20px;"> 医保/医保类 </li> <li style="background:#f8f9fb;text-align:right;width:130px;padding-right:20px;">文号：</li> <li style="width:386px;padding-left:20px;"> 乐医保联合〔2022〕1号 </li> <li style="background:#f8f9fb;text-align:right;width:130px;padding-right:20px;">发布机构：</li> <li style="width:386px;padding-left:20px;"> 市医疗保障局 </li> <li style="background:#f8f9fb;text-align:right;width:130px;padding-right:20px;">成文日期：</li> <li style="width:386px;padding-left:20px;"> 2022-01-27 </li> <li style="background:#f8f9fb;text-align:right;width:130px;padding-right:20px;">有效性：</li> <li style="width:386px;padding-left:20px;"> 有效 </li> </ul> <script> var a = "乐医保联合〔2022〕1号市医疗保障局" //console.log(a); if (!a) { $(".wh").hide(); } </script> </td> </tr> <tr> <td colspan="2" width="100%" height="10"></td> </tr> <tr> <td colspan="2" class="bt_content" style="padding:0 30px;"> <div id="zoom" style="text-align:left;font-size:16px;"> <p><span style="font-size: 14px; font-family: 宋体;">各有关单位</span><span style="font-size: 14px; font-family: 宋体;">:</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">经研究决定</span>,<span style="font-family:宋体">现将《</span></span><span style="font-family:宋体;font-size:14px;">乐清市</span><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞣桨浮酚》⒏忝?/span>,<span style="font-family:宋体">请认真组织贯彻执行。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体"><br/></span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体"><br/></span></span></p><p style="font-size: 14px; text-indent: 2em; text-align: right;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">乐清市医疗保障局</span> <span style="font-family:宋体">乐清市公安局</span></span></p><p style="font-size: 14px; text-indent: 2em; text-align: right;"><span style="font-family:宋体;font-size:14px;">乐清市卫生健康</span><span style="font-family:宋体;font-size:14px;">局</span></p><p style="font-size: 14px; text-indent: 2em; text-align: right;"><span style="font-family:宋体;font-size:14px;">2022<span style="font-family:宋体">年</span></span><span style="font-family:宋体;font-size:14px;">1</span><span style="font-family:宋体;font-size:14px;">月</span><span style="font-family:宋体;font-size:14px;">27</span><span style="font-family:宋体;font-size:14px;">日</span></p><p style="font-size: 14px; text-align: center;"><span style="font-family:宋体;font-size:14px;"><br/></span></p><p style="font-size: 14px; text-align: center;"><span style="font-family:宋体;font-size:14px;">乐清市进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞣桨?/span></p><p style="font-size:14px;"><br/></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">根据《国家医保局</span> <span style="font-family:宋体">公安部</span> <span style="font-family:宋体">国家卫生健康委关于进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞯耐ㄖ罚ㄒ奖：?/span>2021<span style="font-family:宋体">〕</span><span style="font-family:Calibri">224</span><span style="font-family:宋体">号）及《浙江省医疗保障局</span></span><span style="font-family:宋体;font-size:14px;">浙江省公安厅</span><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">浙江省卫生健康委员会关于进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞯耐ㄖ罚ㄕ阋奖Ａⅰ?/span>2021<span style="font-family:宋体">〕</span><span style="font-family:Calibri">27</span><span style="font-family:宋体">号）要求，持续保持打击诈骗医?；鹞シǚ缸锔哐固?，结合我市打击欺诈骗保专项整治工作实际，决定在全市范围内组织开展进一步加强打击欺诈骗保专项整治行动，特制定本工作方案。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">一、总体要求</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（一）行动目标</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">在全市深入开展打击欺诈骗保专项整治行动基础上，结合我市实际，选取突出问题和重点项目组织开展专项整治，集中力量严厉打击。通过集中整治，抓点带面，点面结合，逐层突破，规范引导，进一步完善制度，强化管理，建立健全医?；鸺喽焦芾沓ばЩ?。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（二）行动时间</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">专项整治行动时间延长至</span>2022<span style="font-family:宋体">年</span><span style="font-family:Calibri">12</span><span style="font-family:宋体">月</span><span style="font-family:Calibri">31</span><span style="font-family:宋体">日。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（三）整治对象和范围</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">专项整治覆盖全市所有定点医药机构、参保人员，覆盖</span>2020<span style="font-family:宋体">年</span><span style="font-family:Calibri">1</span><span style="font-family:宋体">月</span><span style="font-family:Calibri">1</span><span style="font-family:宋体">日以来纳入基本医疗保险基金支付范围的所有医药服务行为和医药费用，重点聚焦“假病人”“假病情”“假票据”（以下简称“三假”）等欺诈骗保行为。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">（四）专项整治重点内容</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">聚焦医?；鸺喙苤氐懔煊?，强化部门协同联动检查，日常检查与重点检查相结合，专项整治与飞行检查相结合，深化打击诈骗医?；鸸ぷ鞯墓愣群蜕疃?。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">1.<span style="font-family:宋体">聚焦我市医疗机构、乡镇卫生院、村卫生室等定点医疗机构，严厉查处虚假住院、伪造医疗文书、虚构医疗服务等行为。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">2.<span style="font-family:宋体">聚焦医养结合定点医疗机构，重点是民营医疗机构，严厉打击各类虚假就医、虚构病情、虚构医药服务等行为。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">3.<span style="font-family:宋体">聚焦口腔、中医理疗、医用耗材等重点专科、重点领域，严厉打击重复收费、分解项目收费、串换收费、超标准收费、虚假收费等行为；</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">4.<span style="font-family:宋体">聚焦提供血液透析的定点医疗机构，严厉惩处虚记透析次数、串换诊疗项目、过度检查、过度诊疗等</span></span><span style="font-family:宋体;font-size:14px;">“</span><span style="font-family:宋体;font-size:14px;">假透析</span><span style="font-family:宋体;font-size:14px;">”</span><span style="font-family:宋体;font-size:14px;">行为。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">5.<span style="font-family:宋体">聚焦基因检测，严肃查处篡改肿瘤患者基因检测结果，使用医保肿瘤靶向药危害群众健康的恶劣行为。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">6.<span style="font-family:宋体">聚焦岁末年初，重拳整治医?？ㄍ换飨?、兑付现金乱象。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">7.<span style="font-family:宋体">聚焦我省“五个一批”重点任务，持续发力，克尽全功。</span></span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">二、工作要求</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（一）提高思想认识。</span><span style="font-family:宋体;font-size:14px;">将专项整治作为今年本部门的重点工作，加强组织领导，精心谋划实施，明确工作职责、建立问题台账，确保工作责任到人。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（二）深化部门联动。</span><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">完善医保、公安、卫生健康等部门间的线索通报、案件移送、研判会商、联合行动等工作机制，构建</span>“医、患、管”同频共振综合监管体制。医保、卫生健康部门要进一步提升日常监管能力，及时发现并惩戒骗保问题和不规范医疗服务行为。公安部门要及时打击各种诈骗医?；鸬姆缸镄形?，以案促改，确保专项整治取得实效。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（三）强化线索发现。</span><span style="font-family:宋体;font-size:14px;">充分利用医保智能监管系统和大数据分析、生物识别等技术，深挖涉嫌诈骗医?；鹞シǚ缸镄形咚?，及时锁定可疑线索，精准发力。要广泛征集诈骗医?；鹞侍庀咚?，主动开展明察暗访，对问题线索逐一核查，限期清零。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（四）宽严相济处理。</span><span style="font-family:宋体;font-size:14px;">严格按照医?；鸺喙芊煞ü嬉罂辜喽郊觳?，重点打击幕后组织者、职业骗保人等，对涉案不深的初犯、偶犯依法从轻处理，对认罪认罚、主动投案的医务人员、患者依法从宽处理。依法加强对涉嫌骗?；?、个人的失信惩戒，提高违法成本。拓宽举报渠道，依规给予举报人高限奖励。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（五）曝光典型案件。</span><span style="font-family:宋体;font-size:14px;">定期开展打击欺诈骗保形势分析，梳理汇总欺诈骗保案例，结合专项整治重点任务，及时曝光欺诈骗保典型案例，让违法行为无处可藏，形成有力震慑氛围，提升社会对各类欺诈骗保行为的识别能力。</span></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（六）及时分析汇总。</span><span style="font-family:宋体;font-size:14px;">及时梳理专项整治行动进展情况，分析典型案例，按期总结上报。</span></p><p style="font-size:14px;"><br/></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">（此页无正文）</span></p><p style="font-size:14px;"><br/></p><p style="font-size: 14px; text-indent: 2em;"><span style="font-family:宋体;font-size:14px;">乐清市</span><span style="font-family:宋体;font-size:14px;">医疗保障</span><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">局办公室</span> </span> <span style="font-family:宋体;font-size:14px;">20</span><span style="font-family:宋体;font-size:14px;">22</span><span style="font-family:宋体;font-size:14px;">年</span><span style="font-family:宋体;font-size:14px;">1</span><span style="font-family:宋体;font-size:14px;">月</span><span style="font-family:宋体;font-size:14px;">27</span><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体">日</span> <span style="font-family:宋体">印发</span></span></p><p style="font-size: 14px;"><span style="font-family:宋体;font-size:14px;"><span style="font-family:宋体"><a href="/module/download/downfile.jsp?classid=0&filename=2cd20c273ea84ecdbc713d3d21a02fdc.pdf"><img style="border:none;" src="/module/jslib/icons/acrobat.png"/>乐医保联发〔2022〕1号乐清市医疗保障局乐清市公安局乐清市卫生健康局关于印发《乐清市进一步加强打击诈骗医?；鹱ㄏ钫涡卸ぷ鞣桨浮返耐ㄖ?pdf</a></span></span></p><p><br/></p> </div> </td> </tr> <tr> <td bgcolor="#FFFFFF" style="padding:8px 0px;"></td> </tr> </table> <div class="bshare-custom" style="padding: 15px 0;text-align: right;"><a title="分享到微信" class="bshare-weixin"></a><a title="分享到新浪微博" class="bshare-sinaminiblog"></a><a title="分享到QQ空间" class="bshare-qzone"></a><a title="分享到QQ好友" class="bshare-qqim"></a><a title="更多平台" class="bshare-more bshare-more-icon more-style-addthis"></a><span class="BSHARE_COUNT bshare-share-count">0</span></div> <script type="text/javascript" charset="utf-8" src="http://static.bshare.cn/b/buttonLite.js#style=-1&uuid=&pophcol=3&lang=zh"></script> <script type="text/javascript" charset="utf-8" src="http://static.bshare.cn/b/bshareC2.js"></script> </div> </div> <div class="footer"> <div class="foot"> <script src="/script/0/2101181525034342.js"></script> </div> </div> </div> </div><script id="barrierfree" src="/module/jslib/accessiblereading/load.js"></script><iframe src='../../../../module/visitcount/visit.jsp?type=3&i_webid=1828&i_columnid=1229145291&i_articleid=1997092' name="vishidden" id="vishidden" frameborder="0" style="display:none"></iframe> <script language="javascript" src='/script/web_front.js'></script> <script language="javascript" src='//zjjcmspublic.oss-cn-hangzhou-zwynet-d01-a.internet.cloud.zj.gov.cn/jcms_files/jcms1/web3242/site/script/0/2005061115113094.js'></script> <a href="http://www.taoyidie.com/">天天中彩</a> <script> (function(){ var bp = document.createElement('script'); 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