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73岁“无痛取卵”?国家医保局披露违法违规案例
Zhong Guo Xin Wen Wang·2025-09-29 02:52

Core Insights - The National Healthcare Security Administration (NHSA) has revealed multiple cases of illegal and irregular activities in the healthcare sector, emphasizing the importance of data quality and regulatory oversight in the era of big data [1][12]. Group 1: Data Quality Issues - A doctor was found to have prescribed niacinamide at a total amount over 200 times the national average, leading to an investigation that uncovered data quality issues due to incomplete information in the hospital's records [2]. - A 73-year-old patient was mistakenly recorded as undergoing "painless egg retrieval" instead of a "painless gastrointestinal endoscopy" due to a data entry error, highlighting the need for better data validation mechanisms [3][5]. - An 86-year-old patient was incorrectly diagnosed with "in vitro fertilization" due to a similar data entry mistake, which further underscores the importance of accurate data entry in healthcare [5][6]. Group 2: Regulatory Actions - The NHSA's flying inspection team found that a doctor was involved in issuing multiple prescriptions for semaglutide in a short time frame, indicating potential fraudulent activities, which led to further investigations [7]. - The inspection revealed that a medical representative was collecting social security cards from multiple individuals to facilitate fraudulent prescriptions, prompting the hospital to take disciplinary actions against the involved doctor [7]. - An anomaly was detected where male patients were recorded as receiving hysteroscopy services due to coding errors, which triggered a regulatory alert and necessitated a review of the hospital's coding practices [8][11]. Group 3: Recommendations for Improvement - The NHSA has called for healthcare institutions to enhance their data quality management practices, emphasizing the need for strict audits and dynamic checks before data submission [12]. - It is recommended that healthcare institutions and NHSA collaborate closely to ensure accurate data entry and monitoring, thereby safeguarding public funds and improving healthcare service delivery [12].