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定点零售药店医保合规法律风险及建议

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定点零售药店纳入门诊统筹管理后,不少药店出现串换药械、无处方售药刷用统筹基金、进销存数据管理不规范、不核验参保人员医疗保障凭证售药、为其他机构提供医保结算、诱导协助他人冒名或虚假购药、超限定使用范围及适应症售药等违规行为,造成医保基金损失.定点零售药店应当完善药品配售流程,加强岗前培训,执行合规审计制度,真正实现风险全闭环管理.
Legal Risks and Suggestions on Compliance of Medical Insurance in Designated Retail Pharmacies
After designated retail pharmacies are included in the overall planning of outpatient services,many pharmacies have committed violations such as exchanging drugs and devices,overall planning fund for the drugs without prescription,non-standardized management of purchase,sale and storage data,failure to verify the healthcare security certificates of insured persons,provision of medical insurance settlement for other institutions,induction or assistance in others'purchase of drugs in false name or in a false manner,and selling drugs beyond the limited scope of use and indications,causing losses to medical insurance funds.Designated retail pharmacies shall improve the drug rationing process,strengthen pre-post training,implement compliance audit system,and truly achieve full closed-loop risk management.

designated retail pharmacieslegal responsibilityillegal and irregular scenariosmanagement suggestions

冯世民

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湖南恒昌医药集团股份有限公司法律合规部 长沙 410000

定点零售药店 法律责任 违法违规场景 管理建议

2024

中国医疗保险
中国医疗保险研究会

中国医疗保险

影响因子:0.492
ISSN:1674-3830
年,卷(期):2024.(7)
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