Core Viewpoint - The Beijing Medical Insurance Bureau has extended its regulatory oversight from designated medical institutions to healthcare workers, implementing a "driving license-style scoring" system for those involved in the use of medical insurance funds [1][2]. Group 1: Regulatory Changes - The new regulations will impose penalties on healthcare workers based on their actions related to medical insurance fund usage, with a scoring system that can lead to suspension or termination of their medical insurance payment qualifications [2][3]. - The scoring system categorizes responsibilities into general, important, and primary, with specific point deductions for various violations, such as exceeding procurement limits or providing services without proper registration [3]. Group 2: Scoring System Details - Healthcare workers can accumulate points throughout the year, with a threshold of 9 points leading to a temporary suspension of their payment qualifications, while reaching 12 points results in a three-year termination of their qualifications [2][3]. - Specific violations are assigned point values, with serious infractions leading to higher deductions, such as 12 points for illegal activities resulting in the revocation of professional licenses [3]. Group 3: Implementation and Monitoring - The scoring will be recorded in a centralized database, allowing for cross-institutional and cross-regional tracking and sharing of information regarding healthcare workers' compliance [3]. - The regulatory framework aims to enhance accountability among healthcare professionals and ensure the proper use of medical insurance funds in Beijing [1][2].

各地坚持兼顾医保基金安全和提高基金使用效率并重，充分考虑统筹地区基金运行情况、定点医药机构 需求和信用情况，选择多种方式推进即时结算改革，最大限度压缩结算周期，提高周转效率，减轻医药 机构资金运行压力。河北、浙江、安徽、河南等省份选用提高拨付频次的方式，吉林、黑龙江、广西等 省区选用压缩月结算时长的方式，北京、上海等省份选用按月预拨的方式。 国家医保局表示，下一步，将持续分类指导，扎实推进即时结算改革，让改革成果惠及更多定点医药机 构，提升患者就医体验，改善医药行业生态环境，进一步促进"三医"协同发展和治理。 国家医保局近日发布数据显示，截至3月31日，全国24个省份实施医保基金即时结算，覆盖定点医药机 构24.67万家，拨付金额1657亿元。其中，定点医疗机构10.47万家，拨付金额1574亿元；定点药店14.20 万家，拨付金额83亿元。此外，各地协同推进即时结算和基金预付，2025年预付基本医保基金723亿 元。 国家医保局表示，2025年国家医保局进一步自我革命，强化作风建设，积极回应定点医药机构需求，积 极稳妥推进医保与定点医药机构即时结算，为医药机构发展赋能。其中，各级医保部门建立健全工作联 络机 ...

Core Viewpoint - The implementation of the instant settlement reform for medical insurance funds in China is set to significantly improve the financial operations of hospitals, enhance patient experiences, and promote the collaborative development of the healthcare, medical insurance, and pharmaceutical sectors. Group 1: Reform Overview - In 2024, a unified and improved prepayment system for medical insurance funds will be established at the national level, with a total prepayment scale of 72.3 billion yuan in the first quarter of 2025, addressing the funding pressure faced by hospitals [1] - The instant settlement reform aims to shift from a "post-payment" model to a timely payment system, alleviating the financial burden on hospitals and patients [1][2] - The National Medical Insurance Administration has set a goal for 80% of coordinated regions to achieve instant settlement by 2025, with full coverage expected by 2026 [2] Group 2: Implementation and Impact - As of March 2025, 24 provinces have implemented instant settlement, covering 246,700 designated medical institutions with a total payment amount of 165.7 billion yuan, effectively easing operational pressures on hospitals [2] - Innovative mechanisms in provinces like Anhui and Shandong have significantly reduced payment timelines, enhancing cash flow for medical institutions and improving the overall efficiency of the pharmaceutical industry [3] - The reform allows patients to avoid upfront payments for medical expenses, reducing the time and effort spent on reimbursement processes, thereby improving the overall healthcare experience [3]

截至2月底，全国共103个统筹地区开展即时结算，占统筹地区总数的26%，覆盖定点医疗机构4.37万 家，定点药店6.76万家，即时结算拨付金额387.31亿元。 人民财讯3月11日电，据国家医保局公众号，为促进三医协同发展和治理，健全与"1+3+N"多层次医疗 保障体系相适应的医保科学结算体系，进一步优化医保基金支付方式和结算政策，今年1月9日，国家医 保局印发了《关于推进基本医保基金即时结算改革的通知》（医保办发〔2025〕1号），要求各省严格 落实医保基金预付，推进即时结算。 安徽、山东、广东、河南、青海等省份率先出台省级即时结算文件，其中，安徽在全国第一个印发文件 并在全省范围启动改革，该省已开通即时结算医疗机构569家，结算20.23万人次，拨付医保基金4.72亿 元。 各地立足实际，结合医保基金结余情况，在确保基金安全的前提下，采取多种方式压缩结算周期，增加 拨付频次，提高资金周转效率，取得积极改革成效。 ...

以下文章来源于财经三分钟 ，作者杨瑞 财经三分钟 . 4 亿中产财经资讯平台，专注深度财经商业报道。由财经媒体人杨瑞团队执笔，出品《广州租售同 权》、《北京学区房多校划片》、《国家抢占人工智能制高点》等多篇千万级刷屏文章。 作者： 杨瑞 来源： 财经三分钟（ID： qgq1818 ） 江苏无锡虹桥医院，多个部门密谋诈骗医保基金。在医保局介入调查后，一整个诈骗链条终于浮出水 面。 更让人震惊的是，这样恶劣而猖狂的诈骗医保基金事件并不只发生在一家医院身上。 老百姓的"救命钱"时刻都被人惦记着。 不过，正义迟早会到来。那些双手沾上腐败之臭的犯罪分子，终将会被法律制裁。 目前无锡虹桥医院骗保事件的所有相关人员已经全部落网。 ▲图 源：央视新闻 01 猖狂骗保， 无锡虹桥医院销毁证据对抗调查 涉嫌骗保后，无锡虹桥医院并没有配合调查，而是拼尽一切毁灭证据，其中包括了集体串供、篡改病 历、销毁账簿以及修改数据等等。 然而百密一疏，医保局和当地公安局还是找到了蛛丝马迹，最终还原了整个作案链条。 首先，医院内部人士和中介勾结。 随后，中介以一定报酬为诱找人假冒成病人。假病人进入医院后，会被安排住院1-2天，期间医院会 为假病人 ...