随着医疗保障的全面覆盖和医疗技术水平的提升,医保基金支出呈增长势头,医药机构的违法违规行为愈加隐匿。本文通过阐述安徽省铜陵市义安区零售药店医保稽核管理的现状,围绕当前存在的问题,整理分析零售药店检查方法,提出加大稽核力度、创立稽核人才梯队、引入第三方稽核机构、建设信息化数据化的医保子系统等对策,以期为零售药店医保基金监管提供借鉴。

With the universal coverage of healthcare security and the improvement of medical technology, the expenditure of medical insurance funds has increased, and the illegal behaviors of medical institutions and drug stores have become more hidden. This paper expounds the current situation of the medical insurance audit management of retail pharmacies in Yi'an District, Tongling City of Anhui Province, analyzes the inspection methods of retail pharmacies over current problems, and puts forward countermeasures such as strengthening the audit, building an audit talent team, introducing third-party forces, and building an information-based and data-based medical insurance subsystem, in order to provide reference for the supervision of medical insurance funds of retail pharmacies.