智能监管
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倒查两年半,剑指医院、药店违规乱象!又一省启动医保飞检
21世纪经济报道· 2025-07-05 07:27
Core Viewpoint - The article discusses the upcoming provincial-level inspections of medical insurance funds in Hunan, emphasizing the importance of safeguarding these funds for the benefit of insured individuals and the overall healthcare system [2][5]. Group 1: Overview of Inspections - The Hunan Provincial Medical Insurance Bureau announced a special inspection of medical insurance funds from July to September 2025, covering the usage from January 1, 2023, to June 30, 2025 [2]. - The inspections aim to enhance the supervision of medical insurance funds, with a focus on high-risk areas and behaviors, including fraudulent practices in medical institutions and retail pharmacies [7][10]. Group 2: Inspection Methodology - The inspections will utilize a "no prior notice" approach, allowing for unannounced checks at designated medical institutions [9]. - Key features of the inspections include a cross-checking mechanism, high professional standards, and the formation of specialized teams to improve efficiency [10]. Group 3: Targeted Areas of Concern - Specific areas of focus include fraudulent hospital admissions, excessive hospitalization rates, and violations related to prescription transfers and drug procurement [10][11]. - Retail pharmacies will be scrutinized for fraudulent practices such as falsifying prescriptions and engaging in drug trafficking [11]. Group 4: Broader Regulatory Context - The article highlights ongoing efforts to combat medical insurance fraud, including recent cases of significant fraud involving millions in claims [15]. - The introduction of smart regulatory measures, such as the mandatory scanning of drug traceability codes for insurance settlements, aims to reduce fraudulent activities [16]. Group 5: Involvement of Third Parties - Third-party organizations are increasingly involved in the oversight of medical insurance fund usage, enhancing the regulatory framework through data-driven approaches [17].
石油化工工程质量监督总站服务天津南港乙烯项目群监管纪实
Zhong Guo Zhi Liang Xin Wen Wang· 2025-04-17 07:13
Core Viewpoint - A modern chemical industrial city is emerging in the Tianjin South Port Industrial Zone, with a focus on a 1.2 million tons/year ethylene and downstream high-end new materials industry cluster project, which is expected to drive a trillion-level downstream industrial chain development [1] Group 1: Quality Assurance - The Tianjin South Port Ethylene Project Supervisory Team has adopted a three-in-one regulatory model combining daily inspections, special checks, and joint supervision, identifying 3,654 issues and completing over 300 acceptance checks in the past two years [1][2] - The team emphasizes not only the physical quality but also the management system, implementing a strict entry mechanism for supervisory engineers, with 22 passing written tests and 35 undergoing on-site assessments [2] Group 2: Technological Innovation - The use of drones for aerial inspections has allowed the team to create 3D models of the project, completing over 100 panoramic models and accumulating more than 3,000 minutes of flight time [2] - A "sky and ground" regulatory system has been established, with over 600 issues identified through a visual management platform, and a mobile enforcement platform ensuring problem rectification [2] Group 3: Talent Development - The supervisory team has developed a unique training system, including a "dual mentor system" for new employees, pairing them with professional and ideological mentors [4] - The team has organized over 50 technical training sessions in the past two years, fostering a competitive atmosphere of learning and improvement [4] Group 4: Team Dynamics - The average age of the supervisory team is 35, showcasing a young and dynamic workforce dedicated to ensuring the quality of the trillion-level chemical city construction [5]