Go homepage(回首页) Upload pictures (上传图片) Write articles (发文字帖)
The author:(作者)hpmailerpublished in(发表于) 2013/11/17 8:57:29 Jiangxi Yichun private hospital nursing home together cash sickness benefits
November 17, Reuters new media in Nanchang, Xinhua (reporter Hu Jinwu Lai Xing) for seeking kickbacks, some nursing home in Yichun city of Jiangxi province and private hospitals have joined together into a larger bailout idea. They give patients admitted to nursing home rebates, over-treatment increased medical expenses, medical claims for reuse vulnerability auditing is not strict, and profit. "Chinese Site" investigative journalist was informed that since last year, 4 in yuanzhou district in Yichun city of Jiangxi province's procuratorial organs investigated and dealt with the relevant duty crime, involving more than 800,000 yuan.
More than 800,000 yuan relief funds stolen
In 2009, yuanzhou District Civil Affairs Bureau policies, district-wide nursing home into the scope of home medical care for the elderly, except at designated hospital doctor can enjoy a new rural medical insurance, medical aid policy can also take home.
Policy after the introduction, several local nursing home and private hospitals were soon playing "concocting". According to the characteristics of the high rate of homes for the elderly, sick, and earn money towards the cause, yuanzhou district integration of two new private hospital dedicated to the reimbursement of hospital nursing home advocacy, said it will provide specialized ambulances door-to-door, free feeding of patients, the whole process of nursing, "one-stop" services.
But "one-stop" service under package, hiding ulterior interests chain. Yuanzhou District Prosecutor's Office investigators revealed that the two private hospitals through the "buy" home for the President, treated sick old man, Xiao dazhi, light was very ill hospital to increase revenues through overtreatment, violations take bailout money. Since last year, yuanzhou district misappropriated relief funds of more than 800,000 yuan.
It is understood that the sick elderly and kickbacks into the bilateral exchange of resources. The second half of 2009, two private nursing home, hospital staff went to binzhou town, suggesting that home for the President, as long as the nursing home patients sent to them for treatment, nursing home administrators will be able to get the rebate. Agree to cooperate, six months taking kickbacks of more than 5,000 yuan, in August 2010 and will report it to the nursing home the cashier leaf Huang, accounting and management personnel. Officers presentation, by the end of 2011, 4 person Kickback has 4 times more than 41,000 yuan.
Almost at the same time, two private hospitals and "captured" in yuanzhou district of several other big nursing home, rebates are nursing home managers carve up.
Policy alienation into a profit-making tool
In order to alleviate the economic pressures of the great disorders in patients, everywhere, has a special policy on compensation, Huimin money from the people, in order to ensure, and introduce matching policies also provide for the collection and use of funds. However, in some places, good policy has turned into a profit-making tool of the minority, the hospital promised hefty rebates to be induced the greatest attraction of duty crime.
Investigative journalist was informed that, in several cases, private hospital and nursing home managers and 8% rebates into a rule. Hospital accounting tended to follow the rebate into salesman of performance fee, hidden strong, daily check harder to find.
In August 2012, yuanzhou District Public Prosecutor's Office to investigate several large towns in the nursing home in the area and found a number of private hospitals exist in nursing home receiving kickbacks, was investigated. As the investigation progressed, 4 family homes for a total of 12 staff members have been arrested.
Compared with public hospitals, both private hospitals by providing a "one-stop" service, to a certain extent, reduce the workload of the nursing home administrators to enable them in choosing hospitals tend to both private hospitals; send patients in the nursing home in private hospitals, medical expenses total 8% as a rebate to give the nursing home managers.
According to investigators on health management medical claims review process is not strict, part hoax, take bailout money sometimes, but a laissez-faire attitude, contributed to "eating the old" behavior.
Meanwhile, the Civil Affairs Department allocated funds to strive for more superior, on reimbursement of auditing for the great bailout is not strict, weak supervision, leading to cash in frequent, misrepresentation of the bailout.
Cut off the "black hand" also need institutional constraints
Investigators believe that only through institutional management to strengthen the supervision of hospitals private hospitals in particular, can effectively prevent various acts of disturbing medical order in the form of rebates, put an end to cash in, misrepresentation of the bailout.
"The hospital itself is going to change business strategies, with quality services instead of giving rebates to attract the disease. "Who investigators believe that standardized financial regulatory system and Medicare reimbursement process is essential, should accomplish truthful by illness to develop treatment programs, eliminate the phenomenon of free to increase medical costs.
To prevent a similar case in yuanzhou District Public Prosecutor's Office to the local civil affairs and health departments have issued prosecutorial advice. In this regard, yuanzhou District Civil Affairs Bureau said the financial management system will establish the nursing home, home for the Faculty Management Committee will be established through elections, monitoring important matters relating to revenues and expenditures of the compound and the Dean and staff carry out their duties.
Director of the Jiangxi Provincial Academy of social sciences, Institute of law, Cheng Guansong believes that indispensable sound ill Medicaid approval system, establishment of medical information sharing mechanisms, public bailout funds to apply for, disclosure of such information, must intensify social supervision and assessment of applications for social assistance-economic situation, greater transparency in policy implementation.
新华网南昌11月17日新媒体专电 (记者胡锦武 赖星)为贪图回扣，江西宜春市一些敬老院和私立医院竟联手打起了大病救助资金的主意。他们给敬老院回扣收治病人，过度治疗提高医疗费用，再利用医疗报销审核把关不严的漏洞，牟取利益。“中国网事”记者调查获悉，自去年以来，江西宜春市袁州区检察机关查处相关职务犯罪4件，涉案金额达80余万元。
80余万元救助金被侵吞
2009年，袁州区民政局出台政策，将全区敬老院老人纳入民政医疗救助范围，除在指定医院住院看病可以享受农村新型医疗保险外，还可以享受民政医疗大病救助政策。
政策出台后，当地几家敬老院和私立医院很快打起了“歪主意”。根据敬老院老人多、生病率高的特点，为争取病源获取收益，袁州区两家新纳入报销定点医院的私立医院专门到各敬老院进行宣传，表示将提供专门救护车上门接送病人、免费营养餐、全程护理在内的“一条龙”服务。
但是在“一条龙”服务的包装之下，隐藏了不可告人的利益链条。据袁州区检察院办案人员透露，两家私立医院通过“收买”敬老院院长的方式，收治生病老人时，采取小病大治、轻病重医来增加收益，通过过度治疗，违规套取大病救助资金。自去年以来，袁州区被侵吞的大病救助资金达80余万元。
据了解，生病老人和回扣成了双方置换的资源。2009年下半年，两家私立医院工作人员来到彬州镇敬老院，暗示敬老院院长叶某，只要把敬老院的病人送到他们那里治疗，敬老院管理人员便能得到回扣。叶某表示同意合作，半年间收取回扣5千余元，2010年8月叶某又将此事告知敬老院出纳黄某、会计易某以及管理人员叶某。办案人员介绍，截至2011年底，4人先后4次收取回扣款4.1万余元。
几乎同一时间，这两家私立医院又“攻陷”了袁州区另外几家比较大的敬老院，回扣均被各敬老院的管理人员瓜分。
好政策异化成牟利工具
为了减轻大病重病患者的经济压力，各地对大病都有专门的补偿政策，为保证惠民资金用之于民，还出台配套政策规定资金的征收和用途。然而，在一些地方，好政策却变成了少数人的牟利工具，医院许诺的高额回扣成为诱发职务犯罪的最大诱因。
记者调查获悉，这几起案件中，私立医院给予敬老院管理人员8%的回扣成了潜规则。医院做账时往往采取将回扣混入业务员业绩提成中的方式，隐蔽性强，日常检查较难发现。
2012年8月，袁州区检察院对区内几个较大的乡镇敬老院进行调查，发现了多家敬老院都存在收受私立医院回扣的情况，遂立案调查。随着调查的深入，4家敬老院共12名工作人员相继落网。
与公立医院相比，这两所私立医院通过提供“一条龙”服务，在一定程度上减轻了敬老院管理人员的工作负担，使其在选择医院时更倾向于上述两家私立医院；私立医院在敬老院送来病人后，均以医疗费用总额的8%作为回扣给予敬老院管理人员。
据办案人员介绍，卫生管理部门对医疗报销的审核程序把关不严，对部分虚报、套取救助资金的行为有时还存在放任的态度，助长了“啃老”行为。
与此同时，民政部门为争取更多的上级拨款资金，对大病救助资金的报销在审核上把关不严、监督不力，导致套取、虚报救助资金的情况频发。
斩断“黑手”还需制度约束
办案人员认为，只有通过制度化管理加强对医院特别是私立医院的监管，才能有效防止各种以回扣形式扰乱医疗秩序的行为，杜绝套取、虚报救助资金的情形。
“医院自身要改变经营策略，要以优质服务代替给予回扣来吸引病源。”这名办案人员认为，规范的财务监管制度和医保报销程序必不可少，应做到如实按病情制定治疗方案，杜绝随意提高医疗费用的现象。
为杜绝类似案件发生，袁州区检察院对当地民政和卫生部门分别发出了检察建议。对此，袁州区民政局表示，将建立健全敬老院财务管理制度，敬老院将通过选举设立院务管理委员会审议、监督院内重要事宜、财务收支和院长及工作人员履行职责的情况。
江西省社会科学院法学研究所所长程关松认为，健全的大病医疗救助各项审批制度不可或缺，建立大病医疗救助信息共享工作机制，公开大病救助资金申领、发放等各项信息，必须加大社会监督力度和对申请社会救助对象经济状况的评估，提高政策执行的透明度。
赞