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id="newstit">新疆定點醫藥機構醫?；鹱圆楣ぷ饕妼嵭?/h1> <h4 class="sub"></h4> <div class="author cf"></div> <div class="channel cf"> <div class="col-1-1 fl"> 2025年10月14日22:01 | </div> <div class="col-1-2 fr"> <span class="rm_type"><img src="/img/2020wbc/imgs/icon_type.png" alt=""><i>小字號</i></span> </div> </div> <div class="rm_txt_con cf"> <div class="bza"><span></span><p></p></div> <div class="box_pic"></div> <p style="text-indent: 2em;">為全面整治醫?；鹗褂妙I域違法違規行為、壓實定點醫藥機構主體責任，新疆于2025年組織全區各定點醫藥機構開展醫?；疬`法違規使用自查自糾工作，通過 “數據賦能篩查、精準對照核查、嚴格結果運用” 三維發力，推動工作深入肌理、見行見效，切實加固醫?；鸨O管 “自查自糾防線”。</p> <p style="text-indent: 2em;"><strong>數據賦能精準篩查，可疑線索“靶向定位”</strong></p> <p style="text-indent: 2em;">今年自查自糾工作以“數據驅動”為核心抓手，依托大數據分析模型，對定點醫藥機構的醫保結算數據、診療服務記錄等信息進行全方位、多維度篩查分析，精準鎖定診療服務異常、費用結算可疑等線索。篩查形成的可疑線索及時下發至各定點醫藥機構，指導其開展針對性自查，既避免了“大水漫灌”式自查的盲目性，又提升了問題排查的精準度與效率，為自查自糾工作“精準發力”奠定堅實基礎。同時，各級醫保局持續加強對線索核查工作的全流程指導，通過專題培訓、現場督導等方式，幫助定點醫藥機構掌握核查標準、規范核查流程，確?？梢删€索核查到位，堅決實現問題線索“清倉見底”。</p> <p style="text-indent: 2em;"><strong>對照清單全面核查，重點領域“深挖細查”</strong></p> <p style="text-indent: 2em;">為確保自查工作無盲區、無遺漏，自治區醫保局印發自查自糾問題清單，涵蓋12個重點領域、183項具體問題，包括各科室通用類問題及骨科、康復、口腔、臨床檢驗等?？祁I域問題，同時明確了6類典型違規行為、19項重點核查內容。各定點醫藥機構嚴格對照問題清單，重點排查虛構醫藥服務項目、誘導或協助虛假購藥、串換藥品/項目等違規行為，同時結合《診療目錄》等政策文件，全面核查政策執行落地情況，確保自查工作既覆蓋“廣度”，又兼具“深度”。</p> <p style="text-indent: 2em;"><strong>整改成效顯著提升，結果運用“真嚴實硬”</strong></p> <p style="text-indent: 2em;">截至2025年7月底，全區已有7000余家定點醫藥機構完成自查自糾材料提交，共排查發現問題9096個，各機構主動退回違規使用醫?；鸪^過去五年自查自糾退回金額總和，充分彰顯了本次自查自糾工作的力度與成效。在結果運用層面，各級醫保部門對自查認真、整改到位的定點醫藥機構，將視情況減少后續現場檢查頻次；對整改不認真、問題整改不到位的機構，依法依規從嚴從重處理，將其納入重點監管對象，加大日常監督檢查力度。同時，引導各定點醫療機構強化問題梳理歸納，以“劃重點、列清單”的方式常態化開展對照自查，切實維護了醫?；鸬陌踩?，進一步壓實了定點醫藥機構使用醫?；鸬闹黧w責任。</p> <p style="text-indent: 2em;">來源：新疆醫保局</p><div class="zdfy clearfix"></div><center><table border="0" align="center" width="40%"><tr></tr></table></center> <div class="box_pic"></div> <div class="edit cf">(責編：陳新輝、楊睿)</div> <p class="paper_num"><em class="section-common-share-wrap">分享讓更多人看到 <i 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