新华财经北京9月16日电（记者彭韵佳）国家医保局日前公布了第一批定点医药机构相关人员违法违规 的典型案例，涉及伪造病历、虚构医药服务、重复收费等违法违规行为。 这是医保支付资格管理制度落实以来，首次对外公开的典型案例。 2025年1月1日起，医保支付资格管理制度正式实施，即在对违法违规的定点医药机构进行行政处罚、协 议处理之后，依法依规精准认定相关人员的责任，对责任人实行"驾照式记分"，通过监管延伸到人，维 护好医保基金安全。 以内蒙古自治区赤峰市巴林左旗济仁中医医院欺诈骗保为例，该院2023年1月至2025年3月违法违规使用 医保基金204万元，其中有的医务人员批量伪造图像相同、报告雷同、病历一样的医学文书；有的医务 人员一边在本院虚假"挂床"住院，一边从事诊疗活动。 目前，当地医保部门依据相关法律法规和医保服务协议，已追回骗取的医保基金，并处违约金，解除该 机构医保定点服务协议。依据相关实施细则，对该院耿某敏、杜某鑫、李某阳、张某艳、王某忠、特某 根等6名医务人员各记12分，终止医保支付资格3年，对李某梅、刘某茹等2名医务人员分别记10分，暂 停医保支付资格4个月。 该负责人说，下一步，国家医保局将持续收 ...

Group 1 - The National Medical Insurance Administration (NMIA) has intensified the regulation of medical insurance funds by holding individuals accountable for violations, marking a shift from solely punishing institutions to also targeting responsible personnel [1][2] - A case in Jiangxi Province highlighted this approach, where individuals involved in fraudulent activities were penalized with points against their medical insurance payment qualifications, indicating a more stringent accountability system [1] - The introduction of a point-based management system for medical insurance payment qualifications aims to enhance the precision and deterrent effect of regulatory measures, extending oversight to specific individuals within medical institutions [2][3] Group 2 - The regulatory framework emphasizes a balanced approach, combining education and punishment, with mechanisms in place to protect the rights of medical personnel while ensuring accountability [3] - Various provinces have implemented dynamic responsibility recognition mechanisms to ensure that accountability is accurately assigned, preventing generalized or superficial handling of violations [3] - The overarching goal is to ensure the proper and compliant use of medical insurance funds, which are critical for the health and well-being of over 1.3 billion insured individuals in the country [2][3]