摘要
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。
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.
出处
《中国医疗保险》
2024年第7期76-81,共6页
China Health Insurance
关键词
定点零售药店
法律责任
违法违规场景
管理建议
designated retail pharmacies
legal responsibility
illegal and irregular scenarios
management suggestions
