四川：举报违法违规使用医保基金，最高奖励金20万元！
<div class="wx_rich_media_content" id="jsWxContainer"><p style='letter-spacing: 0.578px; outline: 0px; text-align: center; visibility: visible;' data-mpa-powered-by="yiban.io"><br></p><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><br></section><section style='font-size: 16px;'><section style='margin-top: 10px;margin-bottom: 10px;'><section style='display: inline-block;width: 100%;border-width: 1px;border-style: solid;border-color: rgba(0, 122, 170, 0.74);padding: 10px;box-shadow: rgb(204, 204, 204) 0.2em 0.2em 0.3em;'><section style='font-size: 17px;'><p>今年4月，是2024年医保基金监管集中宣传月。</p><p><br>4月18日，四川省医疗保障局相关负责人对公众如何举报医保基金违法违规行为相关政策法规进行了解读。根据《四川省违法违规使用医疗保障基金举报奖励办法》，<strong><span style='color: rgb(0, 122, 170);'>发现医保基金使用违法违规行为并向医保部门举报，可得到最高奖励金20万元，最低不少于200元。</span></strong></p></section></section></section></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51); text-align: center;'><span style='font-size: 17px;'>具体哪些违法违规使用医保基金行为</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51); text-align: center;'><span style='font-size: 17px;'>可以被举报？</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51); text-align: center;'><span style='font-size: 17px;'>符合哪些条件可以获得奖励？</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51); text-align: center;'><span style='font-size: 17px;'>奖金如何计算？</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51); text-align: center;'><span style='font-size: 17px;'>……</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51); text-align: center;'><span style='font-size: 17px;'>来看四川省医疗保障局解读</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51); text-align: center;'><span style='font-size: 17px;'>↓↓↓</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='color: rgb(0, 112, 192);font-size: 17px;'><strong>【举报政策解读】</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='color: rgb(0, 112, 192);font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong>1.哪种行为可以举报？</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>任何违法违规使用医保基金行为，大到欺诈骗取医保基金，小到用医保卡到药店买保健品，只要其行为已造成医疗保障基金损失，就可以举报。</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong>2.哪些途径可以举报？</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>国家医保局的举报电话为：010-89061396、010-89061397；四川省医保局的举报电话为：028-86532510。</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong>3.符合什么条件才能得到奖励？</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>奖励举报人必须要同时符合下列条件：有明确的被举报对象和具体违法违规线索，并提供了有效证据；举报的主要事实、证据事先未被医疗保障部门掌握；举报事项经查证属实，被举报行为已造成医疗保障基金损失；举报人愿意得到举报奖励，并提供可供核查的真实有效身份信息、联系方式等；其他依法依规应予以奖励的必备条件。</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong>4.如何计算举报奖金？</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>四川省举报奖励金额度有个范围：最高不超过20万元，最低不少于200元。奖励金额度按照案值的一定比例计算，这里的案值是指举报事项涉及的应当追回的医保基金损失金额。具体的奖励标准如下：</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>10万元（含10万元）以下部分奖励2%，</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>10万元至100万元（含100万元）部分奖励1.5%，</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>100万元至1000万元（含1000万元）部分奖励1%，</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>1000万元以上部分奖励0.5%计算。</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>举个例子：</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>张三举报A医院长期存在以“C反应蛋白测定”收取“超敏C反应蛋白测定”费用，经属地医保部门调查核实，应追回A医院所造成的医疗保障基金损失180万元。根据奖励标准，奖励金额计算如下：10万元部分按照2%，10万元至100万元部分按照1.5%，超过100万元部分按照1%。即100000*2%+900000*1.5%+800000*1%=2000+13500+8000=23500元。张三可以得到2.35万元的奖金。</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong>5.举报奖励金怎么领取？</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>如果符合举报奖励条件，举报人会收到有关医保部门的通知，在收到通知10个工作日内填写《举报违法违规使用医疗保障基金行为奖励申请表》。如果对奖励金额有异议，可以在收到通知10个工作日内，向发放举报奖励的医保部门提出复核申请。</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='color: rgb(0, 112, 192);font-size: 17px;'><strong>【举报获奖案例】</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='color: rgb(0, 112, 192);font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong>举报属实，奖励4.7万余元</strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><strong><br></strong></span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'>2023年，举报人反映遂宁射洪市某医院存在重复收费、过度检查、不合理收费等违规行为。医保部门现场调查核实，发现该医院存在串换项目收费、过度检查和医嘱、病程记录、处方、辅助检查结果不符等问题，违规金额共计224.82万元。医保部门对其作出追回违规报销金额224.82万元，处违约金280.59万元的处理决定，并给予举报人举报奖励金47463.8元。</span></section><section style='font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; line-height: 1.88rem; font-size: 1.13rem; color: rgb(51, 51, 51);'><span style='font-size: 17px;'><br></span></section><p style='margin-bottom: 8px; font-family: "San Francisco", PingFangSC-Medium, Arial, Helvetica, sans-serif; text-align: center; line-height: 1.875rem; font-size: 1.1875rem; color: rgb(51, 51, 51);'><span class="wxart_image" wx-style='display:inline-block;border-width: 0px;border-style: initial;border-color: initial;width: 850px;display: block;'></span></p><section style='margin-right: 8px; margin-left: 8px; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; letter-spacing: 0.544px; text-align: center;'><span class="wxart_image" wx-style='display:inline-block;outline: 0px;visibility: visible !important;width: 640px !important;'></span></section><p style='margin-right: 8px; margin-left: 8px; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; letter-spacing: 0.544px; text-align: center; line-height: 1.75em;'><br style='outline: 0px;'></p><p style='margin-right: 8px; margin-left: 8px; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, "Helvetica Neue", "PingFang SC", "Hiragino Sans GB", "Microsoft YaHei UI", "Microsoft YaHei", Arial, sans-serif; letter-spacing: 0.544px; text-align: center; line-height: 1.75em;'><br></p>转载声明：本文转载自「四川日报」</div><p></p> 奖励太低了吧，起码是违规金额的一半
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