媒体报道—— 为防医保欺诈骗保，不存在医保资金将出现缺口的情况 2025.11. 10 本文字数：897，阅读时长大约2分钟 据华商报大风新闻，近日，有河南新乡网友在当地一医院就诊时发现，院内贴出一则通知称："接市 局通知，即日起居民医保每天限额报50元，职工医保每天限额150元。"该通知落款为新乡市医保 局，时间为2025年6月13日。此事引发网友关注。 据此前媒体报道，新乡市医保局对此事回应称："新乡市整体医保基金运营情况出来后，如果不限额 运营到12月份，就会出现一个没有钱的情况。" 记者了解到，6月13日，新乡市医疗保障局曾发布《关于明确职工和城乡居民门诊统筹日支付限额的 通知》，其中提出，根据省、市关于开展医保基金管理突出问题专项整治工作部署，为进一步提高医 保基金使用效率，保障参保群众切身利益，维护医保基金安全，要求城乡居民门诊统筹日支付限额 50元，在职职工日支付限额150元，退休职工日支付限额200元，其他待遇政策保持不变。 当地回应—— 为防医保欺诈骗保，不存在医保资金将出现缺口的情况 11月10日，华商报大风新闻记者联系到新乡市医保局办公室，对于有媒体此前采访该局获得"若不 限额年底将出现 ...

Core Viewpoint - The Beijing Medical Insurance Bureau reported the results of a special inspection aimed at combating fraud in medical insurance, revealing that seven medical institutions engaged in various illegal activities, resulting in losses to the medical insurance fund ranging from tens of thousands to hundreds of thousands of yuan. All misappropriated funds have been recovered [1] Group 1: Specific Violations by Medical Institutions - Beijing Jingda Hospital assisted others in impersonating patients to defraud the medical insurance fund, resulting in a loss of 167,200 yuan. The hospital was ordered to return the funds and pay a fine of 334,500 yuan, along with a six-month suspension of its agreement [2] - Beijing Changping Huiren Hospital fabricated medical service items to defraud the medical insurance fund, leading to a loss of 92,291.44 yuan. The hospital was ordered to return the funds and pay a fine of 369,100 yuan, with a six-month suspension of its agreement [3] - Beijing Jingbei Hospital engaged in excessive diagnosis and treatment, duplicate charging, and included non-reimbursable medical expenses in the medical insurance fund, causing a loss of 1,015,700 yuan. The hospital was ordered to return the funds and pay a fine of 1,015,700 yuan [4] - Beijing Cerebrovascular Disease Hospital also committed excessive diagnosis and treatment, duplicate charging, and included non-reimbursable medical expenses, resulting in a loss of 664,600 yuan. The hospital was ordered to return the funds and pay a fine of 664,600 yuan [5] - Beijing Si Hui Traditional Chinese Medicine Hospital was found to have similar violations, causing a loss of 425,400 yuan, and was ordered to return the funds and pay a fine of 425,400 yuan [6] - Beijing Zhongke Yinyi Property Management Co., Ltd. Health Center violated diagnostic norms and included non-reimbursable medical expenses, leading to a loss of 362,700 yuan. The center was ordered to return the funds and pay a fine of 362,700 yuan [7] Group 2: Other Violations - Beijing Beiya Orthopedic Hospital's Western medicine practitioners illegally prescribed traditional Chinese medicine decoctions without the necessary qualifications, resulting in the recovery of over 7.84 million yuan for the improperly prescribed items [8]