数据质量管理
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异常数据引发飞行检查,国家医保局精准查处多起典型案例
Jing Ji Guan Cha Bao· 2025-09-30 02:03
Core Insights - The National Healthcare Security Administration (NHSA) has effectively utilized a unified medical insurance information platform to identify and address multiple cases of abnormal data, showcasing the empowering role of data in regulatory oversight [1] Group 1: Abnormal Data Cases - A physician was found to have prescribed niacinamide at a total amount over 200 times the national average, prompting an investigation into the hospital's medical insurance settlement data [2] - An elderly patient, aged 73, was incorrectly recorded as undergoing "painless egg retrieval" due to a data entry error, while an 86-year-old patient was mistakenly associated with "in vitro fertilization" due to similar coding issues [3] - A doctor was discovered to have issued multiple prescriptions for semaglutide within a minute for different patients, indicating potential fraudulent behavior linked to a medical representative [4] - An analysis revealed over a hundred male patients with billing records for hysteroscopy, which was due to a coding error that confused the local codes for ureteroscopy and hysteroscopy [5] Group 2: Regulatory Actions and Recommendations - The NHSA's flying inspection team confirmed that the medical insurance fund was not harmed and mandated immediate technical corrections from the hospitals involved [6] - The cases highlighted deficiencies in data quality management at designated medical institutions, emphasizing the need for strict pre-upload audits and dynamic daily checks [7] - It is recommended that medical institutions and healthcare departments collaborate closely to enhance monitoring and management of data quality, ensuring the protection of public healthcare funds [7]
有医院为73岁老人开展“无痛取卵”,为86岁老人开展“试管内受精”?国家医保局披露→
第一财经· 2025-09-29 08:42
Core Viewpoint - The article emphasizes the importance of data quality management in healthcare institutions, highlighting how improper data handling can lead to significant regulatory issues and inefficiencies in the healthcare system [3][15]. Group 1: Case Studies of Data Issues - A doctor was found to have prescribed niacinamide at a total amount over 200 times the national average, leading to an investigation that revealed data quality issues due to the use of "unknown" in place of actual doctor names [5][6]. - An elderly patient was mistakenly recorded as undergoing "painless ovum retrieval" instead of the intended "painless gastrointestinal endoscopy" due to incorrect data entry, prompting the need for improved data validation mechanisms [8][9]. - A doctor was found to have issued multiple prescriptions for semaglutide in a very short time frame, indicating potential fraudulent activity, which led to further investigation and corrective actions against the involved medical personnel [10][11]. Group 2: Data Quality Management Recommendations - The article stresses that healthcare institutions must take responsibility for data quality management, ensuring strict audits and timely corrections to prevent regulatory alerts and unnecessary inspections [15]. - It calls for the establishment of a closed-loop management system for problem detection, alerts, and resolution, leveraging technology for better monitoring and cross-verification of data [15]. - Collaboration between healthcare institutions and regulatory bodies is essential to safeguard public funds and ensure accurate data reporting [15].
73岁“无痛取卵”?国家医保局披露违法违规案例
Zhong Guo Xin Wen Wang· 2025-09-29 02:52
Core Insights - The National Healthcare Security Administration (NHSA) has revealed multiple cases of illegal and irregular activities in the healthcare sector, emphasizing the importance of data quality and regulatory oversight in the era of big data [1][12]. Group 1: Data Quality Issues - A doctor was found to have prescribed niacinamide at a total amount over 200 times the national average, leading to an investigation that uncovered data quality issues due to incomplete information in the hospital's records [2]. - A 73-year-old patient was mistakenly recorded as undergoing "painless egg retrieval" instead of a "painless gastrointestinal endoscopy" due to a data entry error, highlighting the need for better data validation mechanisms [3][5]. - An 86-year-old patient was incorrectly diagnosed with "in vitro fertilization" due to a similar data entry mistake, which further underscores the importance of accurate data entry in healthcare [5][6]. Group 2: Regulatory Actions - The NHSA's flying inspection team found that a doctor was involved in issuing multiple prescriptions for semaglutide in a short time frame, indicating potential fraudulent activities, which led to further investigations [7]. - The inspection revealed that a medical representative was collecting social security cards from multiple individuals to facilitate fraudulent prescriptions, prompting the hospital to take disciplinary actions against the involved doctor [7]. - An anomaly was detected where male patients were recorded as receiving hysteroscopy services due to coding errors, which triggered a regulatory alert and necessitated a review of the hospital's coding practices [8][11]. Group 3: Recommendations for Improvement - The NHSA has called for healthcare institutions to enhance their data quality management practices, emphasizing the need for strict audits and dynamic checks before data submission [12]. - It is recommended that healthcare institutions and NHSA collaborate closely to ensure accurate data entry and monitoring, thereby safeguarding public funds and improving healthcare service delivery [12].
Melissa 宣布设立中国办事处,将稳步扩展全球业务布局
Globenewswire· 2025-09-15 00:00
Core Insights - Company will showcase its flagship data quality solutions and core services at two major industry events in China, aimed at e-commerce and logistics enterprises [1][2] - The establishment of a local office in China reflects the company's commitment to support global enterprises through localized services and technical expertise [1] Group 1: Industry Events - Company will debut at the China Cross-Border E-Commerce Exhibition (CCBEC) from September 17-19 and the China (Shenzhen) International Logistics and Supply Chain Expo (CILF) from September 24-26 [2] - The booth numbers are 16C68 for CCBEC and 1B394 for CILF [2] Group 2: Data Quality Solutions - Melissa's global address verification tool is designed for cross-border businesses, supporting validation, correction, and standardization of customer data from over 240 countries and regions [2] - The Global Express Entry feature allows for instant address auto-completion, significantly reducing input errors and ensuring data accuracy [2] - Additional services include global phone number verification and email verification, enhancing communication efficiency and reducing bounce rates [2] Group 3: Local Market Adaptation - The data quality tools have been optimized for export-oriented markets like China, leveraging authoritative reference data for efficient global address, phone number, and email validation [2] - The company is prepared to provide precise support for the vast Chinese market, ensuring billing and delivery addresses are accurate and compliant with local standards [2]