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73岁“无痛取卵”?86岁“试管内受精”?医保局披露多起异常数据案例
Xin Lang Cai Jing· 2025-09-29 03:07
Core Insights - The National Healthcare Security Administration (NHSA) has highlighted issues in data quality management within designated medical institutions, revealing that even minor discrepancies can trigger alerts and lead to unnecessary regulatory inspections, resulting in wasted resources for both healthcare regulation and medical institutions [5] Group 1: Data Quality Issues - A 73-year-old patient was incorrectly recorded as undergoing "painless egg retrieval" instead of a "painless gastrointestinal endoscopy" due to a data entry error [1] - An 86-year-old patient was mistakenly diagnosed with "in vitro fertilization" because of a miscommunication in the coding process, where the doctor only entered initials without verifying the dropdown options [1] - A doctor was found to have issued multiple prescriptions for the same medication within a minute for different patients, raising suspicions of falsified medical records [2] Group 2: Fraudulent Activities - A medical representative collected multiple social security cards and used them to obtain prescriptions for diabetes medications, despite the patients having no prior history of diabetes [2] - The hospital conducted a self-inspection and took disciplinary actions against the involved doctor, including suspension and performance penalties [2] Group 3: Coding Errors - A coding error led to male patients being recorded as having undergone "hysteroscopy," when they actually received "ureteroscopy" treatments, highlighting the importance of accurate coding in medical records [4] - An abnormal prescription volume of niacinamide was detected, attributed to a lack of proper identification of prescribing doctors, resulting in multiple entries under "unknown" [4]