关于禁止使用死亡人员医保凭证就医购药告知书
<p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; line-height: 29pt;"><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt; outline: none !important;">参保人员、定点医药机构：</span></strong></p><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32pt; line-height: 29pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;"><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">医疗保障基金是群众的</span><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">“看病钱”“救命钱”，基金安全关乎医保制度可持续发展和全体参保人切身利益。当前存在少数逝者家属未及时办理停保手续，继续使用逝者医保凭证就医购药，以及部分定点医药机构身份核验不严、参保人员住院死亡后违规持续计费等问题。上述行为违反《医疗保障基金使用监督管理条例》及《实施细则》相关规定，严重威胁医保基金安全。为筑牢基金安全防线、维护社会公平正义、守护好群众“救命钱”，现就有关事项郑重告知如下：</span></span></p><h2 style="box-sizing: border-box; font-family: 宋体; font-weight: bold; line-height: 29pt; color: rgb(69, 69, 69); margin: 0pt; font-size: 18pt; padding: 0pt; text-wrap-mode: wrap; background-color: rgb(255, 255, 255); text-indent: 32pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 黑体; color: rgb(0, 0, 0); font-weight: normal; font-size: 16pt;">一、明确三类禁止情形</span></h2><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32.15pt; line-height: 29pt;"><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 楷体, 楷体_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">（一）未及时办理停保注销。</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">参保人员死亡后，所在单位或家属未在规定时限内办理参保终止及账户注销（职工医保参保人）手续，导致逝者医保凭证仍处于可使用状态。</span></p><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32.15pt; line-height: 29pt;"><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 楷体, 楷体_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">（二）使用逝者医保凭证。</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">死亡人员家属法律意识淡薄、心存侥幸，使用逝者医保凭证就医、购药，违规享受门诊慢（特）病等统筹基金结算待遇。依据《实施细则》，</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">参保人员身故后，其医保凭证自动失效，任何单位和个人不得继续使用</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">。</span></p><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32.15pt; line-height: 29pt;"><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 楷体, 楷体_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">（三）定点机构违规协助套取。</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">明知参保人已死亡，仍不落实身份核验责任，诱导、协助家属使用逝者医保凭证结算，虚构医药服务、伪造票据材料，共同套取医保基金。</span></p><h2 style="box-sizing: border-box; font-family: 宋体; font-weight: bold; line-height: 29pt; color: rgb(69, 69, 69); margin: 0pt; font-size: 18pt; padding: 0pt; text-wrap-mode: wrap; background-color: rgb(255, 255, 255); text-indent: 32pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 黑体; color: rgb(0, 0, 0); font-weight: normal; font-size: 16pt;">二、严格依法依规追究违规法律责任</span></h2><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32pt; line-height: 29pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">所有涉事单位及个人，一经查实违规，将严格依据相关法律法规，从严追究责任，绝不姑息：（一）根据《医疗保障基金使用监督管理条例》第四十一条规定，个人冒名使用他人医保凭证，骗取统筹基金支出的，责令改正并退回损失资金；属参保人员的，</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;"><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">暂停医疗费用联网结算</span><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">3至12个月</span></span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">；以骗取基金为目的的，并处骗取金额</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">2 倍以上5倍以下</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">罚款。（二）《医疗保障基金使用监督管理条例实施细则》相关规定：强化死亡人员医保凭证全链条监管，</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">明确冒用逝者医保凭证结算属于严重违规行为</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">，除执行《条例》处罚外，纳入医保信用黑名单，实施联合惩戒；定点医药机构违规协助套取基金的，责令退回资金，并处骗取金额</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">2 倍以上5倍以下</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">罚款，</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;"><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">暂停</span><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">6个月以上1年以下医保服务资格</span></span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">，情节严重的解除定点服务协议，吊销相关执业资格。（三）刑事责任衔接：违规情节严重、涉嫌犯罪的，依据《中华人民共和国刑法》第二百六十六条，依法移送司法机关追究刑事责任；构成违反治安管理行为的，依法给予治安管理处罚；造成损失的，依法承担民事赔偿责任。</span></p><h2 style="box-sizing: border-box; font-family: 宋体; font-weight: bold; line-height: 29pt; color: rgb(69, 69, 69); margin: 0pt; font-size: 18pt; padding: 0pt; text-wrap-mode: wrap; background-color: rgb(255, 255, 255); text-indent: 32pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 黑体; color: rgb(0, 0, 0); font-weight: normal; font-size: 16pt;">三、规范办理流程，强化合规管理要求</span></h2><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32pt; line-height: 29pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">（一）限时办理参保终止及账户支取。参保人员死亡后，</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;"><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">单位或家属须在</span><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">20个工作日内</span></span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;"><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">，携带逝者死亡证明、经办人身份证等，到医保经办窗口办理参保终止手续，或可直接通过微信小程序</span><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">“安徽医保公共服务”平台办理停保手续。职工医保个人账户有余额的，继承人可持死亡证明、继承人身份证、银行卡等办理余额一次性支取，不得违规留存、使用逝者医保凭证。（二）严守医保政策红线，杜绝侥幸心理。各参保单位及死亡人员家属须自觉遵守医保法律法规，</span></span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">参保人死亡后，立即停止使用其医保凭证</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">，不得冒名就医、购药、结算，不得转让、倒卖逝者医保凭证或药品，切勿因小失大、触犯法律。（三）压实定点医药机构主体责任。各定点医药机构须严格落实</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">实名制就医购药</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;"><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">规定，强化医保政策学习执行，接诊时必须核验就诊人身份与医保凭证一致性，确保</span><span style="font-family:仿宋,仿宋_GB2312;box-sizing: border-box;">“人证相符”。发现使用死亡人员医保凭证、身份信息不符等异常情况，</span></span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">立即停止医保基金结算服务，并报送县医保局</span></strong><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">。对未履行核验责任、违规协助结算的，从严从重查处，绝不姑息。</span></p><h2 style="box-sizing: border-box; font-family: 宋体; font-weight: bold; line-height: 29pt; color: rgb(69, 69, 69); margin: 0pt; font-size: 18pt; padding: 0pt; text-wrap-mode: wrap; background-color: rgb(255, 255, 255); text-indent: 32pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 黑体; color: rgb(0, 0, 0); font-weight: normal; font-size: 16pt;">四、畅通举报渠道，共建基金安全防线</span></h2><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32pt; line-height: 29pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">医保基金安全人人有责。欢迎社会各界、广大群众积极举报使用死亡人员医保凭证、欺诈骗保等违法违规行为。举报电话：</span><strong style="box-sizing: border-box;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">0566-2550001。</span></strong></p><p setedaria="true" tabindex="0" style="box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32pt; line-height: 29pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">特此告知。</span></p><p setedaria="true" tabindex="0" style="text-align:right;box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32pt; line-height: 29pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">东至县医疗保障局</span></p><p setedaria="true" tabindex="0" style="text-align:right;box-sizing: border-box; margin: 0pt; padding: 0pt; color: rgb(69, 69, 69); text-wrap-mode: wrap; background-color: rgb(255, 255, 255); font-size: 10.5pt; font-family: Calibri; text-indent: 32pt; line-height: 29pt;"><span tabindex="0" aria-labelconfig="true" style="box-sizing: border-box; font-family: 仿宋, 仿宋_GB2312; color: rgb(0, 0, 0); font-size: 16pt;">2026 年5月22日</span></p><p><br/></p><link rel="stylesheet" href="//www.dz0566.com/source/plugin/wcn_editor/public/wcn_editor_fit.css?v134_M34" id="wcn_editor_css"/>
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