异常数据引发飞行检查，国家医保局精准查处多起典型案例

Core Insights - The National Healthcare Security Administration (NHSA) has effectively utilized a unified medical insurance information platform to identify and address multiple cases of abnormal data, showcasing the empowering role of data in regulatory oversight [1] Group 1: Abnormal Data Cases - A physician was found to have prescribed niacinamide at a total amount over 200 times the national average, prompting an investigation into the hospital's medical insurance settlement data [2] - An elderly patient, aged 73, was incorrectly recorded as undergoing "painless egg retrieval" due to a data entry error, while an 86-year-old patient was mistakenly associated with "in vitro fertilization" due to similar coding issues [3] - A doctor was discovered to have issued multiple prescriptions for semaglutide within a minute for different patients, indicating potential fraudulent behavior linked to a medical representative [4] - An analysis revealed over a hundred male patients with billing records for hysteroscopy, which was due to a coding error that confused the local codes for ureteroscopy and hysteroscopy [5] Group 2: Regulatory Actions and Recommendations - The NHSA's flying inspection team confirmed that the medical insurance fund was not harmed and mandated immediate technical corrections from the hospitals involved [6] - The cases highlighted deficiencies in data quality management at designated medical institutions, emphasizing the need for strict pre-upload audits and dynamic daily checks [7] - It is recommended that medical institutions and healthcare departments collaborate closely to enhance monitoring and management of data quality, ensuring the protection of public healthcare funds [7]