The issue of " Aier Eye Hospital Group Co.Ltd(300015) hospital inducing the elderly to do cataract surgery to defraud medical insurance" detonated the network again a few days ago. AI Fen, director of the emergency department of Wuhan Central Hospital, posted a picture on her real name certification microblog, saying that Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital forged the optometry and visual acuity results of patients, tricked a 56 year old driving school coach in Kunming to have cataract surgery, and was received by a doctor who did not have professional qualification, suspected of illegal medical practice.
Qing Yunhui, the party involved in the incident, told surging news that he had repeatedly reported the matter to the local health commission and the medical insurance bureau in his real name. According to the report letter provided by Qing Yunhui, he was tricked into cataract surgery after seeing a doctor in Kunming Aier Eye Hospital Group Co.Ltd(300015) . Before the operation, his left eye cornea was transparent, but not only did his vision not improve after the operation, but also the dryness, pain, photophobia and other discomfort in his left eye continued to worsen. Later, he was diagnosed with dry eye in the ophthalmology of the second people's Hospital of Yunnan Province. He reviewed the case and found that the diagnosis and treatment of Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital was false and fabricated the diagnosis conclusion, so as to defraud the medical insurance fund.
In response to Qing Yunhui's report, Kunming Guandu District medical insurance administration made a decision on December 7, 2021. According to the disposal decision, according to the investigation of the special inspection team, Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital has a breach of contract requiring inpatient insured personnel to pay out-patient fees. The medical insurance bureau decided to recover the breach fee of 4320.07 yuan and deduct the breach penalty of 4320.07 yuan according to twice the breach fee, totaling 8640.14 yuan .
the visual acuity after operation is not as good as that before operation
Qing Yunhui's report letter shows that he worked as a coach in a driving school before, never wore glasses and had good eyesight. On November 2, 2020, he went to Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital for the first time. At that time, his left eye vision was measured to be 1.0. Dr. Zhang Kanglin diagnosed "conjunctivitis". After issuing eye drops, he went home.
On November 19 of the same year, when he went to Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital for the second time, his left eye vision was 0.4. Dr. LV Changjie was diagnosed as "cataract" and told him to have surgery, otherwise he would be in danger of blindness. On November 23, he went to the hospital for the third time. His left eye vision was 0.5 measured in the outpatient department and was diagnosed as "cataract". Dr. Zhang Kanglin issued a hospitalization certificate and asked him to be hospitalized for surgery. After paying for hospitalization procedures, Dr. Yang Jianyu performed cataract surgery on him the afternoon of the next day (November 24). Just two hours before operation, hospital also asked him to pay 7100 yuan for femtosecond laser in clinic with theout issuing an invoice.
Qing Yunhui said that just before the operation, he had repeatedly confirmed to Cao minyang, his responsible doctor in charge, what the lens was and whether surgery was needed. Cao minyang introduced it to him and asked him to sign several lists after confirmation.
The next morning after the operation, after removing the gauze covered on his left eye, Qing Yunhui felt that his eyesight had not improved. He immediately asked the surgeon Yang Jianyu, director. Dr. Yang told him that "the operation is very good, there is no problem, just recover and adapt".
However, before the operation, the cornea of his left eye was transparent. After returning home from hospital, he had intermittent fog vision in his left eye. The symptoms of secretions were the same as before the operation, and the discomfort such as dryness, pain and photophobia in his left eye continued to worsen, which made Qing Yunhui feel very painful and confused.
On December 17, 2020, Qing Yunhui went to the Department of Ophthalmology of the second people's Hospital of Yunnan Province and was diagnosed with "dry eye". Only then did he know that his "corneal epithelial exfoliation, dry eye and meibomian gland dysfunction in the left eye" were directly related to the above operations.
the diagnostic doctor is not qualified
Feeling induced to have cataract surgery, Qing Yunhui went to Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital to ask for copies of his medical records and other data. He found that he had not even seen the doctor who signed the medical record, and his vision data had been tampered with.
According to the report letter, on the morning of December 28 of the same year, when Qing Yunhui went to Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital to copy the medical records, he was told that his medical records were spot checked by the medical insurance office of Guandu District and could not be copied. Then, he learned from the medical insurance office that his medical records were not spot checked medical records, and the medical insurance office also called the medical records room of the hospital to let him handle medical records, etc.
At about 3 p.m. that day, Qing Yunhui, who got the complete medical records, found that the name signed by his competent doctor Cao minyang on six medical records was someone else's, and Cao minyang himself was an intern. According to the inquiry of the doctor's home ownership registration information, Cao minyang is not qualified as a doctor, but his photo data is "doctor" in the column of medical staff on the wall of Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital, and it is not indicated that it is an internship. At the same time, Qing Yunhui found that in other medical records, the signature of Dr. Cao minyang was signed by doctors such as Hu Jie, LV Changjie and Yang Jianyu. The real signature of these three doctors was obviously inconsistent with the signature format in his medical records. In one case, the signature of his attending doctor, attending doctor and resident was Hu Jie, but he had never seen Hu Jie. Accordingly, Qing Yunhui suspected Aier Eye Hospital Group Co.Ltd(300015) of forging the doctor's signature, illegal medical practice and false publicity.
Not only that, Qing Yunhui also found that his left eye vision measured in Aier Eye Hospital Group Co.Ltd(300015) outpatient department was 0.5, and then he was admitted to hospital for optometry, and his left eye corrected vision was 0.6. In China, the operation is only arranged when the indication visual acuity of cataract surgery is less than 0.3. He found that the intern Cao minyang in the medical record changed the 0.6 measured by optometry correction of his vision after admission to 0.15 for his left eye after admission, so as to expand the indication of medical surgery and make excessive diagnosis and treatment, which is suspected of defrauding the use of the national medical insurance fund.
recovery of default expenses by medical insurance bureau
For the problems found, Qing Yunhui repeatedly negotiated with Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital, but to no avail. After Dr. Aifen tweeted his experience and the media intervened, the hospital took the initiative to contact him and was willing to compensate more than 10000 yuan for the operation cost. "My eyes have been like this for more than a year, which makes my life worse than death, so I don't agree." Qing Yunhui said.
To this end, Qing Yunhui successively complained to Kunming Health Commission, Kunming Medical Insurance Bureau and other relevant departments about this matter.
On January 5, 2022, Kunming Guandu District Medical Security Bureau publicized Qing Yunhui's complaint handling results on its official website. According to the disposal decision, the special inspection team conducted spot checks and found that Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital had a breach of contract requiring inpatient insured personnel to pay out-patient fees: on November 25, 2021, the medical records of the insured Qing Yunhui were taken on site, and the insured was hospitalized on November 23, 2020 and discharged on November 25, The hospital requires the insured to pay the cost of femtosecond laser surgery during hospitalization on November 24, involving an amount of 7100 yuan. Among the total hospitalization settlement expenses of the insured, the basic medical fund paid 4320.07 yuan and the individual account paid 2561.80 yuan.
According to item (2) of Article 39 of the service agreement for designated medical institutions of Kunming basic medical insurance (2020), it is decided to recover the default fee of 4320.07 yuan, and deduct the default penalty of 4320.07 yuan according to twice the default fee, totaling 8640.14 yuan.
According to tianyancha information, Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital Co., Ltd. is an enterprise controlled by Aier Eye Hospital Group Co.Ltd(300015) and was established on March 9, 2010. In Yunnan, Aier Eye Hospital Group Co.Ltd(300015) established 10 ophthalmic hospitals including Kunming, Chuxiong, Honghe, Yuxi and Dali. According to the "documentary series of ten years of Aier Eye Hospital Group Co.Ltd(300015) entering Yunnan" reported by Kunming local media in September 2020, since 2010, an expert volunteer team led by Yang Jianyu, the national "cataract surgery master" and director of the cataract Department of Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital, has rushed to remote mountain areas in Yunnan every year to carry out eye health examination and popular science for the poor people, Patients with eye diseases were referred to Kunming hospital for free treatment. According to statistics, from 2010 to 2020, Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital alone was responsible for medical assistance and free treatment of more than 15000 cataract patients.
Earlier, according to Red Star News, an insider who once worked in Aier Eye Hospital Group Co.Ltd(300015) disclosed that in promoting free cataract surgery in rural areas, the personnel of Aier Eye Hospital Group Co.Ltd(300015) marketing department would cooperate with local disabled persons' Federation, village cadres and village doctors, provide them with head referral fees, and ask them to help organize the elderly to go to screening. Many rural elderly felt a little blurred in their eyes, The operation is free, so I went to the hospital to expand the scope of vision indications of patients for surgery, "but in fact, part of the hospitalization expenses are reimbursed by the national new rural cooperative medical system, and most of them further use better and more expensive crystals to make up the difference at their own expense".
On January 14, 2022, according to the public disclosure of China Economic Net, Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital and Laibin Aier Eye Hospital Group Co.Ltd(300015) hospital were administratively punished for repeated charges in diagnosis and treatment projects, excessive charges, high charges, allowing patients to be hospitalized but paying in outpatient services and other violations, involving about 2.37 million yuan of medical insurance fund. In addition, Fuyang Aier Eye Hospital Group Co.Ltd(300015) hospital, Binzhou Zouping Aier Eye Hospital Group Co.Ltd(300015) hospital, Baicheng Aier Eye Hospital Group Co.Ltd(300015) hospital, Yicheng Aier Eye Hospital Group Co.Ltd(300015) hospital, Hainan New Hope Liuhe Co.Ltd(000876) Aier Eye Hospital Group Co.Ltd(300015) hospital and other hospitals have been notified of the illegal use of medical insurance funds by the medical insurance bureau.
In this regard, surging news has repeatedly sought confirmation from Kunming Aier Eye Hospital Group Co.Ltd(300015) hospital, and so far there has been no response.
