Legal Risks and Suggestions on Compliance of Medical Insurance in Designated Retail Pharmacies

China Health Insurance ›› 2024, Vol. 0 ›› Issue (7) : 76-81.

China Health Insurance ›› 2024, Vol. 0 ›› Issue (7) : 76-81. DOI: 10.19546/j.issn.1674-3830.2024.7.009
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Legal Risks and Suggestions on Compliance of Medical Insurance in Designated Retail Pharmacies

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Abstract

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.

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designated retail pharmacies / legal responsibility / illegal and irregular scenarios / management suggestions

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Legal Risks and Suggestions on Compliance of Medical Insurance in Designated Retail Pharmacies[J]. China Health Insurance. 2024, 0(7): 76-81 https://doi.org/10.19546/j.issn.1674-3830.2024.7.009

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