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"> <div id="qpkie8q" class="g_show_title"><span>關(guān)于依法依規(guī)使用醫(yī)?；鸬奶嵝押?/span></div> <div id="ayiebwc" class="g_show_rq" style="text-align: center;"> <span>來源：市醫(yī)療保障局</span> <span>時間：2025-05-16 09:02:11</span> <span>瀏覽次數(shù)： <span id="clickCount"></span></span> <script language="javascript"> $.ajax({ type:"post", url:"/intertidwebapp/counter/count", data:{ 'contentID':1324857, 'siteName':'宜興市人民政府', 'siteID':2 }, success:function(data){ $('#clickCount').html(data); }, error: function(XMLHttpRequest, textStatus, errorThrown) { } }); </script> <span>字號：[ <a href="javascript:void(0);" onclick="fontsizeL();">大</a> <a onclick="fontsizeN();" href="javascript:void(0);">中</a> <a onclick="fontsizeS();" href="javascript:void(0);">小</a> ]</span> </div> <div id="8rwciy8" class="g_show_article" id="_content"><span style="font-size: inherit;"> <p>全市參保人員、定點(diǎn)醫(yī)藥機(jī)構(gòu)工作人員：</p> <p>　　根據(jù)國家、省、無錫市醫(yī)保局的統(tǒng)一部署，全市醫(yī)保系統(tǒng)正在深入開展醫(yī)?；鸸芾硗怀鰡栴}專項(xiàng)整治。為加強(qiáng)醫(yī)?；鸨O(jiān)督管理，堅(jiān)決打擊違法違規(guī)使用醫(yī)保基金行為，維護(hù)醫(yī)?；鸢踩F(xiàn)就依法依規(guī)使用醫(yī)?；鹛嵝讶缦拢?/p> <p>　　一、定點(diǎn)醫(yī)療機(jī)構(gòu)“十一個嚴(yán)禁”</p> <p>　　1.嚴(yán)禁通過車接車送，提供免費(fèi)吃喝、免費(fèi)體檢，贈送禮品、返還現(xiàn)金等方式，誘導(dǎo)無住院需求的參保人虛假住院騙保。</p> <p>　　2.嚴(yán)禁通過給予人頭費(fèi)、獎勵提成等方式，拉攏介紹病人虛假住院騙保。</p> <p>　　3.嚴(yán)禁與養(yǎng)老、康復(fù)、護(hù)理機(jī)構(gòu)等勾結(jié)，誘導(dǎo)無住院需求的供養(yǎng)老人、康復(fù)人員、失能人員虛假住院騙保。</p> <p>　　4.嚴(yán)禁聚斂參保人醫(yī)保憑證，通過空刷套刷等方式騙保。</p> <p>　　5.嚴(yán)禁雇傭無資質(zhì)人員冒用他人名義開展診療活動騙保。</p> <p>　　6.嚴(yán)禁偽造、篡改CT、X線、核磁共振、超聲等醫(yī)學(xué)影像資料和臨床檢驗(yàn)檢查報(bào)告騙保。</p> <p>　　7.嚴(yán)禁通過編造麻醉記錄、手術(shù)記錄、理療記錄等方式，虛構(gòu)診療服務(wù)項(xiàng)目騙保。</p> <p>　　8.嚴(yán)禁通過偽造、編造醫(yī)囑、處方，篡改藥品進(jìn)銷存記錄，虛假開具藥品耗材等騙保。</p> <p>　　9.嚴(yán)禁將自費(fèi)整形美容類項(xiàng)目串換為醫(yī)保目錄內(nèi)項(xiàng)目收費(fèi)騙保。</p> <p>　　10.嚴(yán)禁重復(fù)收費(fèi)、分解收費(fèi)、超標(biāo)準(zhǔn)收費(fèi)、過度診療、串換醫(yī)療項(xiàng)目或藥品耗材等違法違規(guī)使用醫(yī)保基金問題。</p> <p>　　11.嚴(yán)禁違反實(shí)名制管理規(guī)定就醫(yī)。</p> <p>　　二、定點(diǎn)零售藥店“十一個不準(zhǔn)”</p> <p>　　1.不準(zhǔn)通過私自印刷定點(diǎn)醫(yī)療機(jī)構(gòu)空白處方，私刻醫(yī)療機(jī)構(gòu)公章、醫(yī)師個人簽章等方式偽造藥品處方騙保。</p> <p>　　2.不準(zhǔn)與醫(yī)藥企業(yè)勾結(jié)偽造藥品處方騙保。</p> <p>　　3.不準(zhǔn)通過互聯(lián)網(wǎng)醫(yī)院平臺，借助人工智能自動生成虛假處方騙保。</p> <p>　　4.不準(zhǔn)斂聚參保人醫(yī)保憑證，通過空刷套刷等方式騙保。</p> <p>　　5.不準(zhǔn)將食品、保健品、生活日用品、化妝品等串換為藥品騙保。</p> <p>　　6.不準(zhǔn)組織本單位員工空刷套刷醫(yī)?？_保。</p> <p>　　7.不準(zhǔn)有組織前往其他單位、企業(yè)等，誘導(dǎo)員工非真實(shí)購藥騙保。</p> <p>　　8.不準(zhǔn)誘導(dǎo)或協(xié)助參保人購藥后進(jìn)行倒賣回流騙保。</p> <p>　　9.不準(zhǔn)通過非法渠道采購“回流藥”進(jìn)行二次銷售。</p> <p>　　10.不準(zhǔn)誘導(dǎo)或協(xié)助他人冒名購藥、超量購藥。</p> <p>　　11.不準(zhǔn)違反實(shí)名制管理規(guī)定購藥。</p> <p>　　三、參保人員“五個不可”</p> <p>　　1.不可冒名使用：不可將本人的醫(yī)療保障憑證交由他人冒名使用。</p> <p>　　2.不可違規(guī)套現(xiàn)：不可利用享受醫(yī)療保障待遇的機(jī)會轉(zhuǎn)賣藥品、接受返還現(xiàn)金或?qū)嵨锾兹♂t(yī)?；稹?/p> <p>　　3.不可虛假就醫(yī)：不可通過虛假診療、虛假治療違規(guī)使用醫(yī)保基金。</p> <p>　　4.不可冒名就醫(yī)：不可使用他人的醫(yī)療保障憑證冒名就醫(yī)、購藥。</p> <p>　　5.不可串換刷卡：不可使用本人醫(yī)療保障憑證購買生活用品等不符合基本醫(yī)療保險基金支付范圍的商品。</p> <p>　　全市參保人員、定點(diǎn)醫(yī)藥機(jī)構(gòu)工作人員要增強(qiáng)法律意識和誠信意識，自覺抵制違法違規(guī)行為，共同打擊欺詐騙保。經(jīng)查實(shí)涉嫌欺詐騙保的，醫(yī)保部門將移送公安機(jī)關(guān)處理。如發(fā)現(xiàn)違法違規(guī)使用醫(yī)?；鸬男袨?，請立即向市醫(yī)保部門舉報(bào)，共同守護(hù)參保群眾的“看病錢”、“救命錢”。</p> <p>　　舉報(bào)投訴電話：12393</p> <p>　　信件郵寄地址：宜興市政務(wù)服務(wù)中心12樓（宜興市醫(yī)療保障局1221室）</p> <p>　　郵編：214200</p> <p style="text-align: right;">　　宜興市醫(yī)療保障局</p> <p style="text-align: right;">　　2025年5月16日</p> </span></div> <link rel="stylesheet" type="text/css" href="/yxwww/css/shareStyle.css" /> <div id="ykkd7r4" class="shareDiv">  <style type="text/css"> #bdshare ul,#bdshare_s ul,#bdshare ul li,#bdshare_s ul li,#bdshare_l_c ul li,#bdshare_m_c ul li,#bdshare_pop ul,#bdshare_pop ul li { list-style:none; 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