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湖北省宜昌市猇亭区居民黄某患阑尾炎后,以其亲友、医疗保险参保人李某名义入住当地一家定点医疗机构。住院期间,其冒名顶替的行为被发现。宜昌市医疗保险管理处在拒付医疗费用的同时,对提供医疗保险本的李某给予了6个月内不能享受基本医疗保险待遇的处罚,对医院也进行了相应处理。及时发现违规行为,从而避免医保基金流失的正是一名医疗保险协管员。聘请医保协管员进行现场核查,是宜昌市医保处为加强和规范协议医疗机构以及协议零售药店监督管理的探索之举。
Huang Yichang City, Hubei Province, Hunchun residents Hwang appendicitis, with their relatives and friends, medical insurance insured Lee named a local fixed-point medical institutions. During hospitalization, his impostor behavior was discovered. Yichang City Medical Insurance Management Office refused to pay medical expenses at the same time, to provide medical insurance, Lee gave 6 months can not enjoy the basic medical insurance benefits of the punishment, the hospital also conducted the appropriate treatment. Timely detection of violations, so as to avoid the loss of medical insurance fund is a medical insurance coordinator. Hired medical insurance coordinators to conduct on-site inspection, Yichang Medicare Department to strengthen and standardize the agreement medical institutions and the agreement retail pharmacies supervision and management of the exploration move.