缘何沦为"药贩子"敛财工具 医保基金是广大群众的"看病钱""救命钱"，然而却有不法分子利欲熏心将手伸向了这里。他们通过精心设计瞄准老年人为目标，疯狂骗取医保基金，触 碰法律红线。 近日，上海检察机关曝光了两起医保诈骗大案，涉案金额合计超千万元。那么，如此惊人数字的背后，究竟藏着怎样隐蔽的骗保黑幕？一张普通的医保 卡，又为何会沦为不法分子的敛财工具？ 普通医保卡 据上海市浦东新区人民检察院指控，2020年1月至2024年3月间，被告人王某等人以非法占有为目的，采取收购他人使用医保卡在医院虚开的药品，或采 取直接使用他人医保卡到医院虚开药品的方式，骗取国家医保统筹基金860余万元。 那么，如此大规模的骗保行为，究竟是如何一步步掩人耳目实施的呢？ 上海市浦东新区人民检察院检察官 胡锦萍：王某有在医院门口收药的行为，有在医院门口搭讪老太太的行为，从被告人王某的身上查获了十几本医保 卡。 搭讪就医老人 逐步组建起"药农"队伍 检察官介绍，王某以医院及医院周边为目标区域，通过搭讪就医老人的方式，逐步拉拢、组建起自己的"药农"队伍。 上海市浦东新区人民检察院检察官助理 张洁：在上海浦东新区的各大医院和社区卫生服务中心，他先 ...

农行的工作人员在制作拓印红包 本报记者 薛瑾 摄 "习惯来网点办业务的客群，很多人的需求已超越了'快'，更在乎'稳'和'暖'。"郭雅丹说，支行2025年末完成了"焕新"，成为农行的新式网点代表之一，已 经从单纯的金融业务柜台，变成了综合性的、具有人情味的"社区服务站"。网点除了常备热水、充电设备等，为市民提供"歇脚点"，还充当了逢年过节活 跃在周边社区的"节假日氛围组"。 在北京海淀中关村南大街的一家银行网点，年过七旬的白大爷走出柜台隔间，接过工作人员递上的一叠手工拓印生肖纹样的红包，笑逐颜开："快到春节 了，来银行取点新钱，留着给孩子们发压岁钱，银行还送了我几个红包，真喜庆！" 临近春节，农业银行北京海淀白石桥支行的大堂比以往客流量更大了些。支行行长郭雅丹告诉中国证券报记者，近期，前来取新钞、换新钞的个人客户和 对公客户比较多，这类现金业务也是网点节前最忙碌的业务之一。为满足市民的年俗需求，农行提前优化了现金调拨，确保各面额的新钞有充足的供应。 "最近，不少老客户反馈说，办业务的体验更好了。比如，不用在集中的座位区人挨着人等待被叫号，而是可以像在咖啡馆闲坐，喝点咖啡、从阅览区拿 本书读一读；办业务的时候，也 ...

国家医疗保障局办公室关于对精神疾病类医保定点医疗机构开展集体约谈的通知 各省、自治区、直辖市及新疆生产建设兵团医疗保障局： 为进一步加强精神疾病类医保定点医疗机构（含综合医院精神科，以下简称精神类定点医疗机构）管 理，严厉打击违法违规使用医保基金乱象，各省级医保部门要于本周日前组织对辖区内所有精神类定点 医疗机构主要负责人进行集体约谈，宣讲医疗保障相关法律法规和监管政策。同时，以近期有关媒体曝 光的湖北省襄阳市、宜昌市部分精神类定点医疗机构和以往医保飞行检查中发现的问题为反面案例，开 展警示教育，强化精神类定点医疗机构合法合规使用医保基金意识。 各省级医保部门要组织本辖区内所有精神类定点医疗机构从即日起全面开展自查自纠，重点聚焦但不限 于诱导住院、虚假住院、虚构病情、虚构诊疗、伪造文书、违规收费等违法违规使用医保基金行为，压 实机构主体责任和机构主要负责人管理责任。各精神类定点医疗机构应于3月15日前完成自查自纠，提 交书面报告，完成涉及违法违规使用医保基金退款。各省级医保部门要于3月底前将自查自纠情况报国 家医保局。 国家医保局今年将重点对精神类定点医疗机构开展专项飞检，对违法违规使用医保基金和自查自纠不到 ...

朝阳区三间房地区定福庄西街社区卫生服务站等8家定点医药机构因不能继续为参保人员提供服务，被 中止医保服务协议。海淀区北安河社区卫生服务中心等3家定点医药机构因已注销等原因，被解除医保 服务协议。参保人员在上述11家医药机构发生的费用医保基金不予支付。 2月1日起，北京市新增6家定点医药机构，7家定点医药机构恢复医保服务。 市医保局介绍，新增的6家定点医药机构分别为：朝阳区东坝地区畅颐园社区卫生服务站、昌平区沙河 社区卫生服务中心丽春湖社区卫生服务站、房山区蒲洼乡东村村卫生室、房山区蒲洼乡宝水村卫生室、 房山区史家营乡柳林水村卫生室、门头沟区大峪街道龙坡社区卫生服务站。同时，朝阳区管庄地区远洋 一方社区卫生服务站等7家定点医药机构恢复医保服务。 （来源：千龙网） ...

朝阳区三间房地区定福庄西街社区卫生服务站等8家定点医药机构因不能继续为参保人员提供服务，被 中止医保服务协议。海淀区北安河社区卫生服务中心等3家定点医药机构因已注销等原因，被解除医保 服务协议。参保人员在上述11家医药机构发生的费用医保基金不予支付。 本报讯（记者 柴嵘）2月1日起，本市新增6家定点医药机构，7家定点医药机构恢复医保服务。 市医保局介绍，新增的6家定点医药机构分别为：朝阳区东坝地区畅颐园社区卫生服务站、昌平区沙河 社区卫生服务中心丽春湖社区卫生服务站、房山区蒲洼乡东村村卫生室、房山区蒲洼乡宝水村卫生室、 房山区史家营乡柳林水村卫生室、门头沟区大峪街道龙坡社区卫生服务站。同时，朝阳区管庄地区远洋 一方社区卫生服务站等7家定点医药机构恢复医保服务。 ...

日前，湖北省医疗保障局办公室印发了《关于印发<湖北省医疗保障定点医药机构绩效评价实施细则（试行）>的通知》，进一步规范医疗保障医药服务 行为，完善定点医药机构绩效评价工作，保障医保基金运行安全，提升医保基金使用效率。 绩效评价工作按自然年度进行，遵循"公开、公平、公正"的原则，科学、真实反映定点医药机构的实际履约情况，绩效评价采用线上数据分析、日常履约 检查和年终汇总相结合的方式进行，日常履约检查和专项检查等发现的违规情况记入年终汇总。 《细则》明确，评价参考指标分为基本服务项、医保服务类型项和加分项，实行"1+M+N"百分制评分，得分累加计算，最后得分（百分制）=实际得分/总 标准分*100+加分项得分/总标准分（总标准分具体按照各定点医药机构类型确定）。其中，"1"是基本服务项，包括年度重点工作、信息管理、日常医保 管理、稽核检查情况等；定点零售药店的"M"包括门诊慢特病、"双通道"及"单独支付"药品、异地联网、门诊统筹配药等4项医疗保障服务类型（各定点 医药机构医保服务类型项以评价年度末的类型为准）；"N"为加分项。 对评价年度内医保部门专项检查、稽核检查等发现有严重违规违约问题，被予以中止医保服务协议 ...

这封表扬信的背后，是呈贡区医保局"制度筑基+模式创新"的持续深耕。2025年，呈贡区医保局建立首 问负责、一次性告知等9项服务制度，编制标准化办事指南，让窗口服务有章可循。为方便群众，服务 大厅严格落实"午间不间断、当日事当日毕"要求，并提供延时服务。2025年累计延时办件202件次，涵 盖异地医保备案、报销等高频业务，实现医保服务与民生需求"零时差"对接。 本报讯 记者侯玉才报道 日前，昆明市呈贡区医疗保障局服务大厅收到一封来自东北籍老人宋师傅的手 写表扬信，字里行间满是对工作人员贴心服务的真挚赞许。 宋师傅是异地参保人员，对办理业务不熟悉，来办事时已临近下班。窗口工作人员主动践行延时服务承 诺，延长工作时间，耐心询问需求、解读政策、梳理材料；其他工作人员全程陪同指引，主动代办复印 资料，用暖心举动彻底打消了老人的异地办事顾虑，老人在信中称赞工作人员"把办事群众当作亲人对 待，真是老年人的贴心人"。 ...

Core Insights - The article highlights the significant improvements in medical services and insurance coverage in the Twelve Division, particularly focusing on day surgery and maternity insurance benefits for flexible employment workers [2][3][4][5] Group 1: Day Surgery Benefits - The implementation of day surgery insurance payment policies has greatly enhanced patient experience, allowing for surgeries to be completed in under 24 hours, with costs significantly reduced [2] - For example, the cost of cataract surgery has decreased by approximately 1800 yuan per visit due to the introduction of day surgery [2] Group 2: Maternity Insurance Enhancements - Flexible employment workers, such as those running online businesses, will be included in maternity insurance coverage starting in 2025, allowing for reimbursement of medical expenses and a maternity allowance of 158 days for natural births [3][4] - The process for claiming maternity benefits has been streamlined, enabling one-stop service at hospitals and direct deposit of allowances into personal bank accounts [4] Group 3: Chronic and Special Disease Management - Patients with chronic diseases can now handle their medical paperwork locally, eliminating the need to travel to distant hospitals for approvals [4] - The Twelve Division has improved the efficiency of cross-province medical services, with significant numbers of patients utilizing these services in 2025 [5] Group 4: Overall Medical Service Improvements - The overall medical service experience has been enhanced, with reduced need for patients to travel for care, leading to a more reassuring healthcare environment [5] - The collaboration between local and regional medical services has improved, ensuring that more families can access quality healthcare close to home [5]

Core Insights - By the end of 2025, the number of basic medical insurance participants in Jiangsu province is expected to reach 81.408 million, maintaining a participation rate of over 95% [1] - During the "14th Five-Year Plan" period, the total expenditure of the medical insurance fund in the province will exceed 1.1 trillion yuan, significantly enhancing the well-being of the population [1] Group 1 - The provincial government has implemented various reforms to strengthen the medical insurance system, including the issuance of the "Implementation Opinions on Deepening Medical Security System Reform" and the establishment of the first medical insurance special plan [1] - A comprehensive "one person, one file" insurance database has been created, achieving city-level coordination and establishing a long-term mechanism to prevent poverty caused by illness [1] - The province has made significant progress in key reforms within the medical insurance sector over the past five years, including the advancement of DRG/DIP payment reform and the establishment of a unified sunshine procurement platform [1] Group 2 - In the next five years, Jiangsu will continue to consolidate the achievements of universal insurance coverage, regulate fund management, and improve the multi-tiered medical insurance system [2] - The province aims to enhance the functions of the maternity insurance system and fully establish a long-term care insurance system, promoting the coordinated development of the "three medicals" [2] - There will be a focus on integrating artificial intelligence with the entire medical insurance process to provide higher quality and more efficient services to the public [2]

Core Viewpoint - The Yulin City Medical Security Bureau has issued a public criticism of the Yulin First Vocational Secondary School for failing to timely report employee death reduction procedures, leading to prolonged improper collection of medical insurance funds by deceased individuals, which poses a risk to the medical insurance fund [1][2]. Group 1: Regulatory Compliance - Timely and accurate updates of medical insurance participant information are essential for the safe operation of the medical insurance fund and the fairness of the medical insurance system, which is a legal obligation of all participating units [2]. - The Yulin First Vocational Secondary School violated the Social Insurance Handling Regulations by not reporting the death of employees within the required 20 working days, resulting in improper fund collection [2][3]. Group 2: Required Actions - All participating units are required to submit information change reports for employee status (including new hires, terminations, and deaths) between the 1st and 10th of each month, as per the regulations [2]. - Participating units must conduct thorough checks on their employee information changes, focusing on unreported deaths, retirements, and other status changes to ensure no discrepancies [3]. - A dynamic management mechanism for participant information must be established, with designated personnel responsible for timely updates to prevent similar violations in the future [3].