Core Insights - The article highlights the efforts of Xining City's Chengxi District Discipline Inspection Commission in enhancing the management of medical insurance funds through a special rectification initiative, recovering a total of 2.0127 million yuan in misappropriated funds and penalties by 2025 [1] Group 1: Supervision and Collaboration - The Chengxi District has established a collaborative mechanism between government oversight and social supervision, forming a team of social supervisors for medical insurance funds [1] - Over 2,550 mutual recognitions of inspection results have been conducted, saving the public over 393,000 yuan in costs [1] - An investment of 788,000 yuan has been made to integrate an intelligent medical insurance supervision system into local livelihood projects, ensuring comprehensive oversight of designated medical institutions [1] Group 2: Political Supervision and Coverage - The commission has strengthened political supervision by implementing targeted deployments and leadership responsibilities, successfully including five village health clinics as designated medical insurance providers, achieving full coverage at the village level [1] - The mobilization for insurance participation has been effectively advanced, with 94,700 urban and rural residents enrolled for the 2026 medical insurance, leading to the highest participation rate in Xining City [1] Group 3: Enforcement and Accountability - The Chengxi District maintains a "zero tolerance" approach towards violations, intensifying the investigation of cases to ensure the safety of medical insurance funds [1] - Since last year, 15 problem leads in the medical field have been investigated, resulting in 15 cases filed, nine individuals receiving disciplinary actions, and three disciplinary inspection recommendations issued [1]

Core Viewpoint - The Inner Mongolia Zhalantun City Market Supervision Administration has initiated a special rectification action to ensure fair drug pricing and the safety of medical insurance funds through a combination of self-inspection and surprise checks [1][2] Group 1: Special Inspection Action - The special inspection focuses on prominent issues, deploying four inspection teams to cover all 125 designated medical insurance pharmacies in the city [1] - The inspection examines two main types of violations: discrepancies between drug price tags and actual medical insurance billing records, and the improper inclusion of non-medical insurance items in medical insurance settlements [1] Group 2: Findings and Measures - During the inspections, some pharmacies were found to have non-compliant price displays and mismatched prices, leading to on-site rectification orders with a mechanism established for follow-up checks [1] - As of now, no instances of "dual pricing" or the swapping of daily necessities for drugs have been found in the designated pharmacies within Zhalantun City [1] Group 3: Future Actions - The Market Supervision Administration plans to maintain the results of the special inspections by establishing a regular joint patrol mechanism, combining surprise checks with ongoing management to effectively safeguard the safety of public medication and medical devices [2]

Core Viewpoint - The Linyi Municipal Government has made significant progress in enhancing the medical insurance system during the "14th Five-Year Plan" period, focusing on ensuring basic medical coverage, promoting reforms, and improving service quality [2][3][4]. Group 1: Medical Insurance Coverage - The basic medical insurance coverage rate in Linyi has remained stable at over 95%, with a total of 252.51 billion yuan invested by various levels of government to support resident insurance [3][4]. - The reimbursement rates for inpatient expenses under employee and resident medical insurance are maintained at 80% and 65%, respectively [3]. Group 2: Medical Assistance and Support - A total of 348.97 million medical assistance cases were recorded, alleviating medical expenses by 14.51 billion yuan during the "14th Five-Year Plan" period [3]. - The reimbursement standard for insured residents' hospital deliveries has been increased to 3,000 yuan, with a 100% reimbursement rate for insured employees [3]. Group 3: Medical Insurance System Reform - Linyi has implemented a centralized procurement policy for drugs and medical consumables, executing 890 types of procured drugs and 40 categories of medical consumables [4]. - The city has conducted 18 price adjustments for medical service projects, reducing prices for 346 items to ease the financial burden on residents [4]. Group 4: Service Improvement Initiatives - The city has launched a "city-wide handling" initiative for 27 medical insurance services, achieving seamless processing for registration and reimbursement [5]. - The direct settlement rate for medical expenses across provinces has improved to 91.96%, with a total of 4.11 billion yuan disbursed for maternity benefits [5]. Group 5: Fund Management and Efficiency - Over the past five years, the total expenditure of the medical insurance fund reached 795.14 billion yuan, benefiting 2.75 billion people [6]. - The city has implemented a prepayment system for qualified medical institutions, with 39.38 billion yuan disbursed as advance payments during the "14th Five-Year Plan" [6]. Group 6: Regulatory Enhancements - A joint meeting system for medical insurance fund supervision has been established, enhancing the regulatory framework and ensuring accountability [7]. - During the "14th Five-Year Plan" period, the city recovered and refused payments amounting to 10.2 billion yuan due to violations of fund usage [7].

"老伴去世两年多，医保卡里还留着近4000元，一直不知道该怎么处理。多亏区纪委监委帮忙，这笔钱 终于取出来了。"近日，南京市高淳区纪委监委核查组在开展回访教育时发现，市民袁某在区医保分局 的帮助下，顺利办理了逝者医保账户余额提取手续，市民中心办事大厅也增设了清退窗口和服务人员， 及时为在场的群众办理退费。 今年以来，高淳区纪委监委以死亡人员医保个账清退工作小口切入，把规范医疗诊疗作为打造"廉洁医 院"的重要内容，聚焦群众反映强烈的重复检验检测问题，扎实推动"一次挂号管三天"、"云胶片"、不 同医疗机构检查检验等9项民生实事落地，惠及群众99万人次，降低或节省医疗费用1600余万元，追回 医保基金1300余万元，有效节约了国家医保和减轻了患者负担，让群众感受到"看得见的变化"。惠友亮 自医保基金管理突出问题专项整治开展以来，高淳区纪委监委强化数据赋能，创新构建大数据监督模 型，将已死亡人员信息与医保支付信息进行比对，发现38名已死亡参保人员仍有购药、就诊记录，涉嫌 骗取医保基金，立即将问题移交区医保分局调查处置。经核查，除部分信息登记、结算时间误差外，确 认有25条异常数据系死者家属持已故人员医保卡违规刷卡所致 ...

中央纪委国家监委网站 杜瑶 陕西省宝鸡市纪委监委强化医保基金管理领域突出问题整治，推动职能部门加强医保基金经办能力建 设、提升管理服务水平，增强就医群众获得感和满意度。图为近日，该市纪检监察干部到市医疗保障经 办中心实地走访，了解有关情况。张华刚 摄 医疗保障关乎人民群众健康福祉，是实现人民群众病有所医的关键一环。习近平总书记指出："要继续 加大医保改革力度，常态化制度化开展药品集中带量采购，健全重特大疾病医疗保险和救助制度，深化 医保基金监管制度改革，守好人民群众的'保命钱'、'救命钱'。" 近日，家住陕西省宝鸡市渭滨区英达路烟厂小区的退休职工宋治乾像往常一样，来到火炬路的一家药店 买药。结账时，药店系统自动关联慢病结算，一个月的用药，宋治乾个人支付120元左右。"以前一个月 的药费得花近600元，纳入门诊慢特病医保之后，省下了不少钱。"宋治乾说。 医疗保障是党和国家减轻群众就医负担、增进民生福祉的重要制度安排。陕西省宝鸡市纪委监委以群众 需求为导向，深入开展医保基金管理领域问题整治，严肃查处欺诈骗保、违规套保、基金失管背后的作 风和腐败问题，压实医疗、医保、医药等职能部门责任，强化协同治理，推动医疗保障事 ...

人民网北京12月13日电 （记者乔业琼）据国家医保局官网消息，今日，全国医疗保障工作会议在 北京召开，总结"十四五"时期医保工作，部署2026年工作。 会议要求，2026年，将持续加大飞行检查力度，实现全国所有统筹地区及各类基金使用主体全覆 盖，对患者自费率畸高且排名全国前列的统筹地区和定点医疗机构开展"点穴式"飞行检查，坚决维护人 民群众健康权益。坚决支持定点医疗机构根据诊疗需要对必需的医保目录内药品应配尽配。对倒卖"回 流药"等违法违规使用医保基金行为零容忍，坚决从严处罚。 会议指出，"十四五"时期，积极推进医药领域腐败以及群众身边不正之风和腐败问题集中整治，扎 实开展医保基金管理突出问题专项整治。全面开展"四不两直"飞行检查，实现全国所有省份全覆盖。5 年来共追回医保资金约1200亿元。创新开展药品追溯码采集和监管应用，累计归集追溯码超1000亿条， 有力打击通过倒卖"回流药"骗取医保基金等违法违规行为。 ...

2025年12月13日，全国医疗保障工作会议在北京召开。国家医保局方面披露，5年来共追回医保资金约 1200亿元。 国家医保局积极推进医药领域腐败以及群众身边不正之风和腐败问题集中整治，扎实开展医保基金管理 突出问题专项整治。全面开展"四不两直"飞行检查，实现全国所有省份全覆盖。5年来共追回医保资金 约1200亿元。创新开展药品追溯码采集和监管应用，累计归集追溯码超1000亿条，有力打击通过倒 卖"回流药"骗取医保基金等违法违规行为。 国家医保局方面表示，2026年，要进一步加强医保基金运行管理，守牢医保基金安全底线。持续加大飞 行检查力度，实现全国所有统筹地区及各类基金使用主体全覆盖，对患者自费率畸高且排名全国前列的 统筹地区和定点医疗机构开展"点穴式"飞行检查，坚决维护人民群众健康权益。坚决支持定点医疗机构 根据诊疗需要对必需的医保目录内药品应配尽配。对倒卖"回流药"等违法违规使用医保基金行为零容 忍，坚决从严处罚。 （文章来源：中国经营报） "十四五"时期，医保事业发展取得积极成效。 ...

Core Insights - The National Medical Insurance Administration announced a focus on combating corruption in the pharmaceutical sector and addressing improper practices related to medical insurance during the 14th Five-Year Plan period [1] - A total of approximately 120 billion yuan in medical insurance funds has been recovered over the past five years [1] - The implementation of innovative drug traceability code collection and regulatory applications has led to the accumulation of over 100 billion traceability codes, effectively combating illegal activities such as the resale of "returned drugs" to defraud medical insurance funds [1] Group 1 - The national medical insurance work conference emphasized the need for concentrated rectification of corruption and improper practices in the medical field [1] - The initiative includes comprehensive "four not two direct" flying inspections to achieve nationwide coverage across all provinces [1] - The recovery of 120 billion yuan in medical insurance funds highlights the effectiveness of the ongoing efforts in the sector [1] Group 2 - The innovative approach to drug traceability has resulted in the collection of over 100 billion traceability codes [1] - This regulatory measure is aimed at curbing illegal activities that exploit the medical insurance system [1] - The focus on drug traceability is part of a broader strategy to enhance the integrity of the medical insurance fund management [1]

Group 1 - The core issue is the implementation of daily reimbursement limits for medical insurance in Xinxiang, with residents capped at 50 yuan and employees at 150 yuan, effective from June 13, 2025 [2][4] - The Xinxiang Medical Insurance Bureau stated that without these limits, the insurance fund could face a deficit by the end of the year, emphasizing the need for efficient fund management [4][6] - The adjustment aims to prevent fraud in the medical insurance system and to standardize medical practices in hospitals and clinics, with the bureau asserting that typical outpatient expenses are around 100 to 200 yuan per visit [7] Group 2 - The bureau clarified that the new limits are not indicative of a funding shortfall but are a preventive measure against fraudulent claims [6][7] - Patients needing to exceed the daily limit are encouraged to self-pay the excess amount, as splitting large expenses over multiple days is not compliant with insurance regulations [7]

Core Viewpoint - The Guangdong Provincial Medical Security Bureau has initiated a special action to combat fraud and illegal use of medical insurance funds, aiming to safeguard the integrity of the medical insurance fund and protect the rights of insured individuals [1] Group 1: Action Details - The special action, termed "Hundred-Day Action," will run from now until the end of December 2025, focusing on collecting clues related to prominent issues in medical insurance fund management [1] - Three main areas of concern for clue collection include: 1. Reselling of medical insurance "return drugs" 2. Excessive prescription of medications 3. Fraud related to maternity benefits [1] Group 2: Reporting and Rewards - The medical security administrative department will provide financial rewards to whistleblowers whose reports meet the criteria, with rewards ranging from a minimum of 200 yuan to a maximum of 200,000 yuan, based on the value of the case [1] - The specific implementation details for the reward system will refer to the local "Reporting Reward Implementation Rules" across the province [1]