Bệnh viện lạm dụng quỹ bảo hiểm y tế

altTT – TP.HCM hiện có gần 140 cơ sở y tế ký hợp đồng khám chữa bệnh bảo hiểm y tế (BHYT) với Bảo hiểm xã hội (BHXH) TP. Trong số này có nhiều cơ sở y tế đã lạm dụng quỹ BHYT để thu lợi cho mình.

Sau khi ký hợp đồng khám chữa bệnh BHYT, các bệnh viện được cơ quan BHXH ứng trước tối thiểu 80% chi phí khám chữa bệnh (dựa trên chi phí của quý trước đã được BHXH TP giám định thanh toán). Nhờ khoản tiền ứng trước này mà các bệnh viện có kinh phí rất lớn để mua thuốc, hóa chất, vật tư tiêu hao phục vụ người bệnh.

Sai chuyên môn

Năm 2010, qua thanh tra, thanh tra Sở Y tế TP phát hiện Bệnh viện đa khoa tư nhân Phổ Quang (2B Phổ Quang, Q.Tân Bình) có nhiều sai phạm trong thực hiện hợp đồng với BHXH TP. Cụ thể là nhiều trường hợp bác sĩ chỉ định thuốc và xét nghiệm không phù hợp với chẩn đoán. Ví dụ thuốc Telfat 180mg (kháng dị ứng) liều thông thường 1 viên/ngày, nhưng bác sĩ kê toa cho bệnh nhân bị ápxe lạnh sau mổ nhọt với liều 4 viên/ngày.

Bệnh nhân được chẩn đoán hạ canxi nhưng cho làm xét nghiệm cholesterol (mỡ trong máu), HDL (mỡ tốt trong máu), LDL (mỡ xấu trong máu), HbsAg (viêm gan siêu vi B), AST (ung thư gan); bệnh nhân rối loạn tiêu hóa cho làm ECG (điện tim); bệnh nhân viêm họng hạt cho xét nghiệm ion của máu; bệnh nhân viêm mũi họng cấp cho xét nghiệm mỡ trong máu, chất cặn bã trong nước tiểu, xét nghiệm chức năng gan, xét nghiệm men gan, xét nghiệm ion của máu và tổng phân tích nước tiểu.

Đặc biệt, có những bệnh nhân còn bị chỉ định thuốc có cùng tác dụng hoặc tác dụng đối kháng nhau trong cùng một toa thuốc, sử dụng cùng một thời điểm. Có bệnh nhân được bác sĩ kê toa thuốc uống cùng lúc bốn loại thuốc kháng viêm, hai loại thuốc kháng dị ứng; có bệnh nhân cùng lúc được cho uống bốn loại thuốc trị ho…

Điều đáng nói là những sai sót nói trên không được giám định viên BHYT ở bệnh viện phát hiện nên BHXH TP đã thanh toán chi phí cho những chỉ định sai phạm về chuyên môn gây tốn kém cho quỹ BHYT.

Đấu thầu mua thuốc… đắt!

Theo quy định, khi mua thuốc, hóa chất, vật tư tiêu hao, các bệnh viện công phải tổ chức đấu thầu, nhưng việc thực hiện đấu thầu mua thuốc của một số bệnh viện rất khó hiểu.

Năm 2010 vừa qua, Thanh tra TP đã kiểm tra việc đấu thầu cung ứng thuốc tại các bệnh viện: Q.1, Q.8, Chấn thương chỉnh hình, phụ sản Hùng Vương và phát hiện các bệnh viện này thành lập tổ chuyên gia, tổ thẩm định nhưng không có đủ chứng chỉ đấu thầu theo quy định. Khi chấm điểm kỹ thuật chọn thuốc trúng thầu, có hồ sơ, biên bản chỉ có một nửa số thành viên chấm điểm có mặt.

Đáng lưu ý là việc xây dựng giá thuốc mời thầu và giá thuốc trúng thầu chưa sát với thực tế. Tại Bệnh viện Hùng Vương, Bệnh viện Chấn thương chỉnh hình TP có một số thuốc giá mời thầu cao hơn giá trúng thầu 50% và một số mặt hàng thuốc được chọn trúng thầu có giá cao hơn giá mời thầu!

Trong công tác thực hiện đấu thầu mua sắm thuốc y tế, nhiều mặt hàng thuốc có giá mời thầu khác nhau giữa các bệnh viện và giá trúng thầu cũng có sự chênh lệch. Có bệnh viện không tổ chức đấu thầu nhưng áp giá thầu cao hơn các bệnh viện khác.

Chính vì vậy chỉ trong một quý, quỹ BHYT phải thanh toán số tiền chênh lệch do mua thuốc giá cao cho Trung tâm y khoa Phước An 4,1 tỉ đồng. Và chỉ với 40 loại thuốc được kiểm tra tại Bệnh viện Q.8, quỹ BHYT phải thanh toán số tiền chênh lệch 2,67 tỉ đồng. Bệnh viện Q.1 có 20 mặt hàng thuốc mua giá cao hơn bệnh viện khác trên 1 tỉ đồng và quỹ BHYT cũng đã thanh toán số tiền chênh lệch này.

Bỏ qua thủ tục

Qua thanh tra việc thu, quản lý và sử dụng quỹ BHYT trên địa bàn TP trong bốn năm gần đây, Thanh tra TP đã phát hiện hầu hết các chứng từ, sổ sách dùng để thanh toán chi phí khám chữa bệnh BHYT có sai sót ở những bệnh viện được thanh tra là Bệnh viện Phổ Quang I, Bệnh viện Mắt Sài Gòn II, Bệnh viện Q.1, Bệnh viện Q.8, Công ty TNHH Trung tâm y khoa Phước An (HEPA).

Hầu hết các chứng từ, hồ sơ thanh toán được kiểm tra ở các bệnh viện trên không có đầy đủ chữ ký trên chứng từ, không lưu toa thuốc, không có chỉ định dùng thuốc, y sĩ… kê đơn thuốc, không tính tiền trên phiếu phát thuốc, không mở sổ sách theo dõi, thống kê các chi phí thuốc theo quy định, số liệu trên chứng từ chi tiết và bảng tổng hợp khác nhau, phiếu chỉ định xét nghiệm không có chữ ký của bác sĩ, không có ngày tháng thực hiện xét nghiệm…

Dù BHXH  TP căn cứ phiếu thanh toán ra viện BHYT để kiểm tra, xác định chi phí khám chữa bệnh làm cơ sở thanh quyết toán, nhưng trên các phiếu này có phiếu để trống không ghi thông tin, hoặc không có đầy đủ chữ ký của những người liên quan, một số đơn vị lại dùng chữ ký bằng dấu khắc sẵn.

Thậm chí, chữ ký trên chứng từ của cùng một người nhưng không đồng nhất, một số phiếu không có chữ ký của bệnh nhân để xác nhận có sử dụng các dịch vụ y tế do bệnh viện cung cấp. Với những sai sót này của bệnh viện là không có cơ sở pháp lý để thanh toán chi phí khám chữa bệnh BHYT, nhưng BHXH TP vẫn thanh toán dựa trên số liệu do bệnh viện đề xuất mà không căn cứ vào chứng từ thực tế.

LÊ THANH HÀ
Báo Tuổi Trẻ

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