Order of the Federal Compulsory Medical Insurance Fund 230. Penalties against health workers for defects in the provision of medical care

ON RECOGNITION OF REGULATIVE LEGAL ACTS OF THE MHIF

In order to bring the regulatory legal acts of the Federal Compulsory Medical Insurance Fund into compliance with the legislation of the Russian Federation, I order:

Approve the List of repealed regulatory legal acts of the Federal Compulsory Health Insurance Fund in accordance with the Appendix.

And about. directors
D.V.REIKHART

Application
to the Order of the Compulsory Medical Insurance Fund
dated October 29, 2008 N 230

SCROLL
REVOKED REGULATIVE LEGAL ACTS OF THE FEDERAL COMPULSORY HEALTH INSURANCE FUND

1. “Settlement sheet for contributions to the Federal and territorial compulsory health insurance funds”, approved by the Compulsory Medical Insurance Fund dated January 21, 1994;

4. Order of the Compulsory Medical Insurance Fund dated March 13, 1997 N 27 “On improvement and additional measures for the development of the compulsory medical insurance information system”;

5. Order of the Compulsory Medical Insurance Fund dated March 28, 1997 N 35 “On organizing work with letters, complaints and suggestions from citizens”;

6. Order of the Compulsory Medical Insurance Fund dated May 29, 1997 N 49 “On the procedure for registration, processing and analysis of written and oral appeals of citizens”;

7. Order of the Compulsory Medical Insurance Fund dated June 24, 1997 N 59 “On accounting for fixed assets, the procedure for their receipt and write-off in territorial compulsory medical insurance funds” (together with “Methodological recommendations for accounting for fixed assets. The procedure for reflecting in accounting the receipt and write-off of fixed assets in territorial funds compulsory health insurance", approved by the methodological council of the Compulsory Medical Insurance Fund, protocol dated January 31, 1997 N 1);

8. Order of the Federal Compulsory Medical Insurance Fund dated 05.08.1997 N 69 “On approval of the reporting form” (together with the letter of the Ministry of Health of Russia dated 30.07.1997 N 2510/5757-97-23);

9. Order of the Compulsory Medical Insurance Fund dated March 25, 1998 N 33 “On the creation of an expert-coordinating council for informatization of the compulsory medical insurance system”;

10. Order of the Compulsory Medical Insurance Fund dated April 26, 2004 N 27 “On the organization of replication and operation of standard software”;

11. “Methodological recommendations for conducting inspections of the targeted use of funds received by territorial compulsory health insurance funds for the implementation of social support measures for certain categories of citizens in the provision of medicines,” approved by the Compulsory Medical Insurance Fund dated December 29, 2005 N 6790/101i;

12. Compulsory Medical Insurance Order No. 69 dated July 12, 2005 “On introducing amendments to Compulsory Medical Insurance Order No. 51 dated May 24, 2005 “On introducing amendments and additions to Compulsory Medical Insurance Order No. 91 dated December 30, 2004 “On organizing information interaction for the provision of certain categories of necessary medicines” citizens";

13. Order of the Compulsory Medical Insurance Fund dated 15.07.2005 N 72 “On the suspension of the Order of the Compulsory Medical Insurance Fund of 12.07.2005 N 69” On introducing amendments to the Order of the Compulsory Medical Insurance Fund of 24.05.2005 N 51 “On introducing amendments and additions to the Order of the Compulsory Medical Insurance Fund of 30.12.2004 N 91 "On the organization of information interaction to provide necessary medicines to certain categories of citizens";

14. Order of the Federal Compulsory Medical Insurance Fund dated September 1, 2005 N 86 “On the transition to the chart of accounts for budget accounting, approved by Order of the Ministry of Finance of Russia dated August 26, 2004 N 70n”;

15. Order of the Compulsory Medical Insurance Fund dated September 1, 2005 N 87 “On the transition of compulsory health insurance funds to the budget accounting chart of accounts approved by Order of the Ministry of Finance of Russia dated August 26, 2004 N 70n”;

16. Order of the Compulsory Medical Insurance Fund dated October 20, 2005 N 103 “On the order of the Government of the Russian Federation”;

17. Order of the Compulsory Medical Insurance Fund dated 02/07/2006 N 15 “On the creation of a working group”;

18. Order of the Compulsory Medical Insurance Fund dated 14.02.2006 N 21 “On introducing amendments and additions to the Order of the Compulsory Medical Insurance Fund dated 28.12.2005 N 29 “On approval of registers for recording funds for the implementation of social support measures for certain categories of citizens in the provision of medicines”;

19. Order of the Compulsory Medical Insurance Fund dated February 16, 2006 N 23 “On the presentation of budget reports by territorial compulsory medical insurance funds for 2005”;

20. Order of the Compulsory Medical Insurance Fund dated September 21, 2006 N 118 “On approval of the Methodological Recommendations for the conduct by territorial compulsory medical insurance funds of an automated examination of registers of prescriptions of medicines dispensed to citizens entitled to receive state social assistance in the form of a set of social services”;

21. “Methodological recommendations for the conduct by territorial compulsory medical insurance funds of an automated examination of registers of drug prescriptions dispensed to citizens entitled to receive state social assistance in the form of a set of social services,” approved by the Compulsory Medical Insurance Fund dated September 21, 2006;

"On approval of the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance"

Federal Compulsory Medical Insurance Fund
Order
dated December 1, 2010 No. 230
On approval of the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance

In ed. Order of the Federal Compulsory Compulsory Medical Insurance Fund dated August 16, 2011 No. 144

In accordance with the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation” I order:

1. Approve the attached Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance (hereinafter referred to as the Procedure).

2. The heads of territorial compulsory health insurance funds and medical insurance organizations should use the attached Procedure when organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance.

The procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance

I. General provisions

1. This Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance (hereinafter referred to as the Procedure) was developed in accordance with the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Medical Insurance in the Russian Federation " (Collection of Legislation of the Russian Federation, 06.12.2010, No. 49, Art. 6422) and determines the rules and procedure for organizing and conducting control over the volumes, timing, quality and conditions of medical care by medical organizations in the volume and on the terms established by the territorial compulsory health insurance program and the contract for the provision and payment of medical care under compulsory health insurance.

2. The purpose of this Procedure is to regulate measures aimed at realizing the rights of insured persons to receive free medical care in the volumes, terms and conditions of appropriate quality in medical organizations established by the territorial compulsory health insurance program and the agreement for the provision and payment of medical care under compulsory health insurance. participating in the implementation of compulsory health insurance programs.

II. Goals of monitoring the volumes, timing, quality and conditions of providing medical care under compulsory health insurance

3. Control of the volume, timing, quality and conditions of the provision of medical care under compulsory health insurance (hereinafter referred to as control) includes measures to verify the compliance of the medical care provided to the insured person with the terms of the contract for the provision and payment of medical care under compulsory health insurance, implemented through medical economic control, medical and economic examination and examination of the quality of medical care.

4. The object of control is the organization and provision of medical care under compulsory health insurance. Subjects of control are territorial compulsory health insurance funds, medical insurance organizations, medical organizations that have the right to carry out medical activities and are included in the register of medical organizations operating in the field of compulsory health insurance.

5. Control objectives:

5.1. ensuring free provision of medical care to the insured person in the amount and under the conditions established by the territorial compulsory health insurance program;

5.2. protection of the rights of the insured person to receive free medical care in the amount and under the conditions established by the territorial compulsory health insurance program, of appropriate quality in medical organizations participating in the implementation of compulsory health insurance programs, in accordance with contracts for the provision and payment of medical care under compulsory health insurance ;

5.3. prevention of defects in medical care resulting from inconsistency of the provided medical care with the health status of the insured person; non-compliance and/or incorrect implementation of procedures for the provision of medical care and/or standards of medical care, medical technologies by analyzing the most common violations based on the results of control and taking measures by authorized bodies;

5.4. checking the fulfillment by insurance medical organizations and medical organizations of obligations to pay and provide free medical care to insured persons under compulsory health insurance programs;

5.5. checking the fulfillment of obligations by insurance medical organizations to study the satisfaction of insured persons with the volume, accessibility and quality of medical care;

5.6. optimizing the cost of paying for medical care in the event of an insured event and reducing insurance risks in compulsory medical insurance.

6. Control is carried out through medical and economic control, medical and economic examination, and examination of the quality of medical care.

III. Medical and economic control

7. Medical and economic control in accordance with Part 3 of Article 40 of the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Medical Insurance in the Russian Federation” (hereinafter referred to as the Federal Law) - establishing the compliance of information on the volume of medical care provided to insured persons on the basis of the registers of accounts provided for payment by the medical organization, the terms of contracts for the provision and payment of medical care under compulsory health insurance, the territorial compulsory health insurance program, methods of payment for medical care and tariffs for payment of medical care.

8. Medical and economic control is carried out by specialists from medical insurance organizations and territorial compulsory health insurance funds.

9. During medical and economic control, all cases of medical care provided under compulsory health insurance are monitored in order to:

1) checking account registers for compliance with the established procedure for information exchange in the field of compulsory health insurance;

2) identification of a person insured by a specific medical insurance organization (payer);

3) checking the compliance of the medical care provided:

a) territorial compulsory health insurance program;

b) the terms of the contract for the provision and payment of medical care under compulsory health insurance;

c) a current license of a medical organization to carry out medical activities;

4) checking the validity of the application of tariffs for medical services, calculating their cost in accordance with the methodology for calculating tariffs for payment of medical care, approved by the authorized federal executive body, methods of payment for medical care and tariffs for payment of medical care and the agreement for the provision and payment of medical care for compulsory health insurance;

5) establishing that the medical organization does not exceed the volume of medical care established by the decision of the commission for the development of the territorial compulsory health insurance program, subject to payment from compulsory health insurance funds.

10. Violations identified in the registers of accounts are reflected in the act of medical and economic control (Appendix 1 to this Procedure) indicating the amount of reduction in the account for each entry in the register containing information about defects in medical care and/or violations in the provision of medical care.

In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of medical and economic control, drawn up by the relevant act in the form established by the Federal Compulsory Health Insurance Fund, are the basis for the application of measures provided for in Article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care on compulsory health insurance and a list of grounds for refusing to pay for medical care (reducing payment for medical care) (Appendix 8 to this Procedure), and may also be the basis for conducting a medical and economic examination; organizing and conducting examination of the quality of medical care; carrying out repeated medical and economic control, repeated medical and economic examination and examination of the quality of medical care by the territorial compulsory medical insurance fund or medical insurance organization on the instructions of the territorial fund (except for control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation, on territory of which the compulsory health insurance policy was issued).

IV. Medical and economic examination

11. Medical and economic examination in accordance with Part 4 of Article 40 of the Federal Law - establishing compliance of the actual terms of medical care, the volume of medical services presented for payment with the records in the primary medical documentation and the accounting and reporting documentation of the medical organization.

12. Medical and economic examination is carried out by a specialist expert (clause 78 of section XIII of this Procedure).

13. Medical and economic examination is carried out in the form of:

a) targeted medical and economic examination;

b) planned medical and economic examination.

14. Targeted medical and economic examination is carried out in the following cases:

a) repeated requests for the same disease: within 30 days - when providing outpatient care, within 90 days - when re-hospitalization;

b) diseases with an extended or shortened treatment period by more than 50 percent of the established standard of medical care or the average for all insured persons in the reporting period with a disease for which there is no approved standard of medical care;

c) receiving complaints from the insured person or his representative regarding the availability of medical care in a medical organization.

15. Based on the medical and economic control carried out, a planned medical and economic examination is carried out on invoices submitted for payment within a month after the provision of medical care to the insured person under compulsory health insurance, in other cases it can be carried out within a year after the presentation of invoices for payment.

16. When conducting a planned medical and economic examination, the following are assessed:

a) the nature, frequency and causes of violations of the rights of insured persons to receive medical care under compulsory health insurance in the volume, terms, quality and conditions established by the contract for the provision and payment of medical care under compulsory health insurance;

b) the volume of medical care provided by the medical organization and its compliance with the volume established by the decision of the commission for the development of the territorial compulsory health insurance program to be paid from compulsory health insurance funds;

c) the frequency and nature of violations by a medical organization of the procedure for creating account registers.

17. The volume of monthly scheduled medical and economic examinations from the number of bills accepted for payment for cases of medical care under compulsory medical insurance is determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory medical insurance fund in accordance with paragraph 51 of Section VII of this Procedure, and is at least:

8% - inpatient medical care;

8% - medical care provided in a day hospital;

0.8% - outpatient medical care.

If during a month the number of defects in medical care and/or violations in the provision of medical care exceeds 30 percent of the number of cases of medical care for which a medical and economic examination was carried out, in the next month the volume of inspections from the number of bills accepted for payment in cases provision of medical care should be increased by at least 2 times compared to the previous month.

18. In relation to a certain set of cases of medical care, selected according to thematic criteria (for example, the frequency and types of postoperative complications, duration of treatment, cost of medical services) in a medical organization in accordance with the plan agreed upon by the territorial compulsory health insurance fund, a planned thematic medical and economic examination.

19. Based on the results of the medical and economic examination, a specialist expert draws up a medical and economic examination report (Appendix 3 to this Procedure) in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory health insurance fund.

(as amended by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

In accordance with Part 9 of Article 40 of the Federal Law, the results of a medical and economic examination, drawn up by the relevant act in the form established by the Federal Compulsory Health Insurance Fund, are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care assistance for compulsory health insurance and a list of grounds for refusing to pay for medical care (reducing payment for medical care) (Appendix 8 to this Procedure), and may also be the basis for conducting an examination of the quality of medical care.

V. Examination of the quality of medical care

20. In accordance with Part 6 of Article 40 of the Federal Law, examination of the quality of medical care is the identification of violations in the provision of medical care, including assessment of the correct choice of medical technology, the degree of achievement of the planned result and the establishment of cause-and-effect relationships of identified defects in the provision of medical care.

21. An examination of the quality of medical care is carried out by checking the compliance of the medical care provided to the insured person with the contract for the provision and payment of medical care under compulsory health insurance, procedures for the provision of medical care and standards of medical care, and established clinical practice.

22. An examination of the quality of medical care is carried out by an expert on the quality of medical care included in the territorial register of experts on the quality of medical care (clause 81 of Section XIII of this Procedure) on behalf of the territorial compulsory health insurance fund or medical insurance organization.

23. Examination of the quality of medical care is carried out in the form of:

a) targeted examination of the quality of medical care;

b) planned examination of the quality of medical care.

24. A targeted examination of the quality of medical care is carried out within a month after the provision of an insured event (medical services) for payment, with the exception of cases determined by current legislation and the cases set out in subparagraph e) of paragraph 25 of this section.

(as amended by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

25. Targeted examination of the quality of medical care is carried out in the following cases:

a) receiving complaints from the insured person or his representative regarding the availability and quality of medical care in a medical organization;

b) excluded. - Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144;

c) deaths during the provision of medical care;

d) nosocomial infection and complications of the disease;

e) primary access to disability for persons of working age and children;

f) repeated justified appeal for the same disease: within 30 days - when providing outpatient care, within 90 days - when re-hospitalization;

g) diseases with an extended or shortened treatment period by more than 50 percent of the established standard of medical care or the average for all insured persons in the reporting period with a disease for which there is no approved standard of medical care.

26. When conducting a targeted examination of the quality of medical care in cases selected based on the results of a targeted medical and economic examination, the general time frame for conducting a targeted examination of the quality of medical care may increase to six months from the date of submission of the invoice for payment.

When conducting a targeted examination of the quality of medical care in cases of repeated treatment (hospitalization) for the same disease, the established deadlines are calculated from the moment the invoice containing information about the repeated treatment (hospitalization) is submitted for payment.

The time frame for conducting a targeted examination of the quality of medical care from the moment the invoice is submitted for payment is not limited in cases of complaints from insured persons or their representatives, deaths, nosocomial infections and complications of diseases, primary disability of persons of working age and children.

27. Conducting a targeted examination of the quality of medical care in the event of complaints from insured persons or their representatives does not depend on the time that has passed since the provision of medical care and is carried out in accordance with Federal Law of May 2, 2006 No. 59-FZ "On the procedure for considering citizens' appeals Russian Federation" and other regulatory legal acts regulating work with citizens' appeals.

28. The number of targeted examinations of the quality of medical care is determined by the number of cases requiring its implementation on the grounds specified in this Procedure.

29. A planned examination of the quality of medical care is carried out with the aim of assessing the compliance of the volumes, timing, quality and conditions of providing medical care to groups of insured persons, divided by age, disease or group of diseases, stage of medical care and other characteristics, conditions stipulated by the contract for provision and payment medical care under compulsory health insurance.

30. The volume of monthly scheduled examinations of the quality of medical care is determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of Section VII of this Procedure, and is no less than:

(as amended by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

in hospital - 5% of the number of completed cases of treatment;

in a day hospital - 3% of the number of completed cases of treatment;

when providing outpatient care - 0.5% of the number of completed cases of treatment based on the results of medical and economic control.

31. A planned examination of the quality of medical care is carried out in cases of medical care provided under compulsory health insurance, selected:

a) random sampling method;

b) for a thematically homogeneous set of cases.

32. A planned examination of the quality of medical care using a random sampling method is carried out to assess the nature, frequency and causes of violations of the rights of insured persons to timely receipt of medical care of the volume and quality established by the territorial compulsory health insurance program, including those caused by improper implementation of medical technologies that led to a deterioration in health status the insured person, additional risk of adverse consequences for his health, suboptimal use of the resources of the medical organization, dissatisfaction with the medical care of the insured persons.

33. A planned thematic examination of the quality of medical care is carried out in relation to a certain set of cases of medical care provided under compulsory health insurance, selected according to thematic criteria in each medical organization or group of medical organizations providing medical care under compulsory health insurance of the same type or in the same conditions.

The choice of topics is carried out on the basis of performance indicators of medical organizations, their structural divisions and specialized areas of activity:

a) hospital mortality, frequency of postoperative complications, initial disability of people of working age and children, frequency of re-hospitalizations, average duration of treatment, cost of medical services and other indicators;

b) the results of internal and departmental quality control of medical care.

34. The planned thematic examination of the quality of medical care is aimed at solving the following tasks:

a) identification, establishment of the nature and causes of typical (repetitive, systematic) errors in the diagnostic and treatment process;

b) comparison of the quality of medical care provided to groups of insured persons divided by age, gender and other characteristics.

35. A planned examination of the quality of medical care is carried out in each medical organization that provides medical care under compulsory health insurance at least once during the calendar year within the time limits determined by the inspection plan (clause 51 of Section VII of this Procedure).

36. An examination of the quality of medical care may be carried out during the period of provision of medical care to the insured person (hereinafter referred to as an in-person examination of the quality of medical care), including at the request of the insured person or his representative. The main goal of an in-person examination of the quality of medical care is to prevent and/or minimize the negative impact of defects in medical care on the patient’s health.

An expert in the quality of medical care, with notification to the administration of a medical organization, can conduct a tour of the divisions of a medical organization in order to monitor the conditions for the provision of medical care, prepare materials for an expert opinion, and also advise the insured person.

During the consultation, the insured person who applies is informed about his state of health, the degree of compliance of the medical care provided with the procedures for the provision of medical care and standards of medical care, the contract for the provision and payment of medical care under compulsory health insurance with an explanation of his rights in accordance with the legislation of the Russian Federation.

37. The quality of medical care expert who carried out the examination of the quality of medical care draws up an expert opinion (Appendix 11 to this Procedure) containing a description of the conduct and results of the examination of the quality of medical care, on the basis of which an act of examination of the quality of medical care is drawn up.

(as amended by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of the examination of the quality of medical care, drawn up by the relevant act in the form established by the Federal Compulsory Health Insurance Fund (Appendices 5, 6 to this Procedure), are the basis for applying to a medical organization the measures provided for in the article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care under compulsory health insurance and a list of grounds for refusing to pay for medical care (reducing payment for medical care) (Appendix 8 to this Procedure).

Based on certificates of examination of the quality of medical care, authorized bodies take measures to improve the quality of medical care.

VI. The procedure for the territorial compulsory medical insurance fund to control the activities of medical insurance organizations

38. The Territorial Compulsory Medical Insurance Fund, on the basis of Part 11 of Article 40 of the Federal Law, exercises control over the activities of medical insurance organizations by organizing control over the volumes, timing, quality and conditions of medical care, conducts medical and economic control, medical and economic examination, examination of the quality of medical care. help, including again.

39. Repeated medical-economic examination or examination of the quality of medical care (hereinafter referred to as re-examination) - a medical-economic examination carried out by another specialist expert or another expert on the quality of medical care, an examination of the quality of medical care in order to verify the validity and reliability of conclusions on previously accepted conclusions made a specialist expert or an expert on the quality of medical care who initially conducted a medical and economic examination or examination of the quality of medical care.

A repeated examination of the quality of medical care can be carried out in parallel or sequentially with the first using the same method, but by a different expert on the quality of medical care.

40. The objectives of re-examination are:

a) checking the validity and reliability of the conclusion of a specialist expert or expert on the quality of medical care who initially conducted the medical and economic examination or examination of the quality of medical care;

b) monitoring the activities of individual expert specialists/experts on the quality of medical care.

41. Re-examination is carried out in the following cases:

a) the territorial compulsory medical insurance fund conducts a documentary inspection of the organization of compulsory medical insurance by a medical insurance organization;

b) identifying violations in the organization of control on the part of the medical insurance organization;

c) the unfoundedness and/or unreliability of the conclusion of the expert on the quality of medical care who conducted the examination of the quality of medical care;

d) receipt of a claim from a medical organization that has not been settled with the medical insurance organization (clause 73 of section XI of this Procedure).

42. The territorial compulsory medical insurance fund notifies the medical insurance organization and the medical organization about the re-examination no later than 5 working days before the start of work.

To conduct a re-examination to the territorial compulsory health insurance fund, within 5 working days after receiving the relevant request, the medical insurance organization and the medical organization are required to provide:

medical insurance organization - copies of medical and economic control, medical and economic examination and examination of the quality of medical care necessary for re-examination;

medical organization - medical, accounting and reporting and other documentation, if necessary, the results of internal and departmental quality control of medical care, including those carried out by the health care management body.

43. The number of cases subject to re-examination is determined by the number of reasons for their conduct in accordance with paragraphs 40, 41 of this Procedure, but not less than 10% of the number of all examinations for the relevant period of time, including at least 30% of re-examinations of the quality of medical care.

During the calendar year, all medical insurance organizations operating in the field of compulsory health insurance must be subjected to re-examination in cases of medical care provided in all medical organizations in proportion to the number of bills presented for payment.

(clause 43 as amended by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

44. The territorial compulsory health insurance fund sends the results of the re-examination, drawn up in an act (Appendix 7 to this Procedure), to the medical insurance organization and medical organization no later than 20 working days after the end of the inspection. The medical insurance organization and the medical organization are obliged to review the specified acts within 20 working days from the date of their receipt.

45. The medical insurance organization and the medical organization, in the event of no agreement with the results of the re-examination, send a signed act with a protocol of disagreements to the territorial compulsory health insurance fund no later than 10 working days from the date of receipt of the act.

The Territorial Compulsory Health Insurance Fund, within 30 working days from the date of receipt, reviews the act with a protocol of disagreements with the involvement of interested parties.

46. In accordance with Part 14 of Article 38 of the Federal Law, the territorial compulsory medical insurance fund, in the event of detection of violations of contractual obligations on the part of an insurance medical organization when reimbursing it for the costs of paying for medical care, reduces payments by the amount of identified violations or unfulfilled contractual obligations.

The list of sanctions for violations of contractual obligations is established by the agreement on financial support for compulsory health insurance, concluded between the territorial compulsory health insurance fund and the medical insurance organization.

In accordance with this agreement, if violations are detected in the activities of a medical insurance organization, the territorial compulsory medical insurance fund uses measures applied to the medical insurance organization in accordance with Part 13 of Article 38 of the Federal Law and the agreement on financial support of compulsory medical insurance or recognizes those applied by the medical insurance organization measures taken against a medical organization are unfounded.

47. The territorial compulsory medical insurance fund, when identifying violations in the organization and conduct of medical and economic examination and/or examination of the quality of medical care, sends a claim to the medical insurance organization, which contains information about the monitoring carried out over the activities of the medical insurance organization:

a) the name of the commission of the territorial compulsory health insurance fund;

b) date (period) of inspection of the medical insurance organization;

c) the composition of the commission of the territorial compulsory health insurance fund;

d) regulatory legal acts that are the basis for monitoring the activities of an insurance medical organization in organizing and conducting control and the reasons for conducting control;

e) facts of improper fulfillment by the medical insurance organization of contractual obligations to organize and conduct control, indicating re-examination reports;

f) the extent of responsibility of the medical insurance organization for identified violations;

g) attachments (copies of re-examination reports, etc.).

The claim is signed by the director of the territorial compulsory health insurance fund.

Fulfillment of the claim is carried out within 30 working days from the date of its receipt by the medical insurance organization, about which the territorial compulsory health insurance fund is informed.

48. If the territorial compulsory medical insurance fund identifies, during a re-examination, violations missed by the medical insurance organization during a medical-economic examination or examination of the quality of medical care, the medical insurance organization loses the right to use measures applied to the medical organization for a medical defect not detected in a timely manner. assistance and/or disruption in the provision of medical care.

49. Funds in the amount determined by the re-examination act are returned by the medical organization to the budget of the territorial compulsory health insurance fund. Sanctions are applied to the medical insurance organization in accordance with the agreement on financial support for compulsory medical insurance.

(clause 49 as amended by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

50. The Territorial Compulsory Health Insurance Fund analyzes requests from insured persons, their representatives and other subjects of compulsory health insurance based on the results of control carried out by the medical insurance organization.

VII. Interaction of subjects of control

51. The Territorial Compulsory Medical Insurance Fund coordinates the interaction of subjects of control on the territory of a constituent entity of the Russian Federation, carries out organizational and methodological work to ensure the functioning of control and protection of the rights of insured persons, coordinates the plans of activities of insurance medical organizations in terms of organizing and conducting control, including plans inspections by medical insurance organizations of medical organizations providing medical care under contracts for the provision and payment of medical care under compulsory medical insurance.

52. When conducting a medical-economic examination and examination of the quality of medical care, the medical organization provides expert specialists and experts on the quality of medical care within 5 working days after receiving the relevant request with medical, accounting, reporting and other documentation, and, if necessary, the results of internal and departmental quality control medical care.

53. In accordance with Part 8 of Article 40 of the Federal Law, a medical organization does not have the right to interfere with the access of expert specialists and experts in the quality of medical care to the materials necessary for conducting a medical and economic examination, examination of the quality of medical care and is obliged to provide the requested information.

54. Employees involved in control are responsible for the disclosure of confidential information of limited access in accordance with the legislation of the Russian Federation.

55. Based on Article 42 of the Federal Law, the resolution of controversial and conflict issues arising during the control between a medical organization and a medical insurance organization is carried out by the territorial compulsory health insurance fund.

The commission informs interested parties and the executive authority of the constituent entity of the Russian Federation in the field of healthcare about the results of resolving controversial and conflict issues, about violations in the organization and conduct of control, in the provision of medical care in a medical organization.

VIII. Accounting and use of control results

56. Reports on the results of the control carried out are provided by medical insurance organizations to the territorial compulsory health insurance fund.

The medical insurance organization and the territorial compulsory medical insurance fund keep records of control acts.

Registration documents may be registers of acts of medical and economic control (Appendix 2 to this Procedure), medical and economic examination and examination of the quality of medical care.

The results of control in the form of reports are transferred to the medical organization within 5 working days.

It is possible to conduct electronic document flow between subjects of control using an electronic digital signature.

57. In the event that the act is delivered to the medical organization personally by a representative of the medical insurance organization/territorial compulsory health insurance fund, all copies of the act are marked with receipt indicating the date and signature of the recipient. When sending the act by mail, the specified document is sent by registered mail (with the preparation of an inventory) with notification.

The act can be sent to a medical organization in electronic form if there are guarantees of its reliability (authenticity), protection from unauthorized access and distortion.

58. The head of a medical organization or a person replacing him reviews the report within 15 working days from the date of its receipt.

If the medical organization agrees with the act and measures applied to the medical organization, all copies of the acts are signed by the head of the medical organization, certified with a seal, and one copy is sent to the medical insurance organization/territorial compulsory health insurance fund.

If the medical organization disagrees with the act, the signed act is returned to the medical insurance organization with a protocol of disagreements.

59. The territorial compulsory health insurance fund, based on an analysis of the activities of the subjects of control, develops proposals that help improve the quality of medical care and the efficiency of using compulsory health insurance resources and informs the executive body of the constituent entity of the Russian Federation in the field of healthcare and the territorial body of the Federal Service for Surveillance in Healthcare social development.

60. In accordance with Article 31 of the Federal Law, filing a claim or lawsuit against a person who caused harm to the health of the insured person in order to reimburse the costs of paying for medical care provided by an insurance medical organization is carried out on the basis of the results of an examination of the quality of medical care, documented in the relevant act.

IX. The procedure for informing insured persons about identified violations in the provision of medical care under the territorial compulsory health insurance program

61. In order to ensure the rights to receive affordable and high-quality medical care, insured persons are informed by medical organizations, medical insurance organizations, territorial compulsory health insurance funds about identified violations in the provision of medical care under the territorial compulsory health insurance program, including the results of monitoring.

62. Work with citizens’ appeals in the Federal Compulsory Medical Insurance Fund, territorial compulsory medical insurance funds and medical insurance organizations is carried out in accordance with the Federal Law of May 2, 2006 No. 59-FZ “On the procedure for considering appeals from citizens of the Russian Federation” and other regulatory legal acts acts regulating work with citizens' appeals.

63. When a medical insurance organization or territorial compulsory medical insurance fund receives a complaint from the insured person or his representative regarding the provision of medical care of inadequate quality, the results of consideration of the complaint based on the results of the examination of the quality of medical care are sent to his address.

64. In medical insurance organizations that organize the service of representatives of medical insurance organizations to carry out work in medical organizations participating in the implementation of compulsory health insurance programs to protect the rights and legitimate interests of insured persons, representatives of medical insurance organizations take part in the preparation and placement of information materials on protection of the rights of insured persons and the results of control, and also provide insured persons receiving medical care in medical organizations with information and explanatory materials on their rights.

X. The procedure for applying sanctions to a medical organization for violations identified during control

65. Based on Part 1 of Article 41 of the Federal Law, the amount not payable based on the results of medical and economic control, medical and economic examination, examination of the quality of medical care is withheld from the amount of funds provided for payment for medical care provided by medical organizations or is subject to return to a medical insurance organization in accordance with the contract for the provision and payment of medical care under compulsory health insurance, a list of grounds for refusal to pay for medical care or a reduction in payment for medical care in accordance with this Procedure.

66. The result of control in accordance with the contract for the provision and payment of medical care under compulsory health insurance and the list of grounds for refusal to pay for medical care (reduction in payment for medical care) are:

a) non-payment or reduction of payment for medical care in the form of:

exclusion of an item from the register of invoices subject to payment for volumes of medical care;

reducing the amounts presented for payment as a percentage of the cost of medical care provided for an insured event;

return of amounts not subject to payment to the medical insurance organization;

b) payment of fines by a medical organization for failure to provide, untimely provision or provision of medical care of inadequate quality (in the event of an insured event in which defects in medical care and/or violations in the provision of medical care were identified).

67. Non-payment or reduction of payment for medical care and payment of fines by a medical organization in accordance with subparagraph b) of paragraph 66 of this section, depending on the type of identified defects in medical care and/or violations in the provision of medical care, can be applied separately or simultaneously.

68. If violations of contractual obligations are identified in relation to the volume, timing, quality and conditions of providing medical care, the insurance medical organization does not partially or fully reimburse the costs of the medical organization for providing medical care, reducing subsequent payments on the medical organization’s bills by the amount of identified defects in medical care and/ or violations in the provision of medical care or requires the return of amounts to the medical insurance organization.

The amount not subject to payment based on the results of control is withheld from the amount of funds provided for payment for medical care provided by a medical organization, or is subject to return to the medical insurance organization in accordance with the agreement for the provision and payment of medical care under compulsory medical insurance.

69. For failure to provide, untimely provision, or provision of medical care of inadequate quality, the medical organization pays a fine in accordance with the list of grounds for refusal (reduction) of payment for medical care (Appendix 8 to this Procedure) on the basis of an order containing:

a) the heading part (number and date of the order, place of issue, name of the organization that carried out the control and the medical organization in respect of which the fine is applied);

c) the prescriptive part (code of a defect in medical care/violation in the provision of medical care in accordance with Appendix 8 to this Procedure, the amount and deadline for payment of the fine);

d) the final part (informing about the possibility of appealing the order in accordance with the legislation of the Russian Federation, signature of the head (deputy head) of the organization that carried out the control).

(clause 69 as amended by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

70. If in one and the same case of medical care there are two or more grounds for refusal to pay for medical care or a reduction in payment for medical care, one more significant ground is applied to the medical organization, entailing a larger amount of non-payment or refusal to pay. The amount of incomplete payment for medical services for one insured event is not summed up.

71. Non-payment or incomplete payment for medical care, as well as payment by a medical organization of fines for failure to provide, untimely provision or provision of medical care of inadequate quality does not exempt the medical organization from compensating the insured person for harm caused through the fault of the medical organization, in the manner established by the legislation of the Russian Federation.

72. Funds received as a result of the application of sanctions to a medical organization for violations identified during control are spent in accordance with Federal Law.

XI. Appeal by a medical organization against the conclusion of an insurance medical organization based on the results of control

73. In accordance with Article 42 of the Federal Law, a medical organization has the right to appeal the conclusion of a medical insurance organization based on the results of control within 15 working days from the date of receipt of the certificates of the medical insurance organization by sending a claim to the territorial compulsory health insurance fund according to the recommended sample (Appendix 9 to this in order).

The claim is made in writing and sent along with the necessary materials to the territorial compulsory health insurance fund. A medical organization is obliged to provide to the territorial compulsory health insurance fund:

a) justification for the claim;

b) a list of questions for each disputed case;

c) materials of internal and departmental quality control of medical care in a medical organization.

74. The Territorial Compulsory Medical Insurance Fund, within 30 working days from the date of receipt of the claim, reviews the documents received from the medical organization and organizes repeated medical and economic control, medical and economic examination and examination of the quality of medical care, which, in accordance with Part 4 of Article 42 of the Federal laws are formalized by a decision of the territorial fund.

75. The decision of the territorial compulsory medical insurance fund, recognizing the correctness of the medical organization, is the basis for canceling (changing) the decision on non-payment, incomplete payment for medical care and/or payment by the medical organization of a fine for failure to provide, untimely provision or provision of medical care of inadequate quality based on the results primary medical and economic examination and/or examination of the quality of medical care.

The territorial compulsory health insurance fund sends a decision based on the results of the re-examination to the medical insurance organization and to the medical organization that sent the claim to the territorial compulsory health insurance fund.

(paragraph introduced by Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

Changes in funding based on the results of consideration of controversial cases are carried out by the medical insurance organization no later than 30 working days (during the period of final settlement with the medical organization for the reporting period).

76. If a medical organization disagrees with the decision of the territorial fund, it has the right to appeal this decision in court.

XII. Organization by the territorial compulsory medical insurance fund of control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which the compulsory medical insurance policy was issued

77. The organization by the territorial compulsory medical insurance fund of control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which the compulsory medical insurance policy was issued is carried out in accordance with sections III - V of this Procedure.

XIII. Workers carrying out medical and economic examination and examination of the quality of medical care

78. In accordance with Part 5 of Article 40 of the Federal Law, a medical and economic examination is carried out by a specialist expert who is a doctor who has worked in a medical specialty for at least five years and has undergone appropriate training in expert activities in the field of compulsory health insurance.

79. The main tasks of the specialist expert are:

a) monitoring the compliance of the medical care provided with the terms of the contract for the provision and payment of medical care under compulsory health insurance by establishing the compliance of the actual terms of medical care, the volumes of medical services provided for payment with the records in the primary medical and accounting and reporting documentation of the medical organization;

b) participation in organizing and conducting an examination of the quality of medical care and ensuring guarantees of the rights of insured persons to receive medical care of appropriate quality.

80. The main functions of a specialist expert are:

a) selective control of the volume of medical care for insured events by comparing actual data on medical services provided to the insured person with the procedures for providing medical care and standards of medical care;

b) selection of cases for examination of the quality of medical care and justification of the need for its implementation, preparation of documentation necessary for an expert of the quality of medical care to conduct an examination of the quality of medical care;

c) preparation of materials for the methodological framework used for the examination of the quality of medical care (procedures for the provision of medical care and standards of medical care, clinical protocols, methodological recommendations, etc.);

d) generalization, analysis of conclusions prepared by an expert on the quality of medical care, participation in the preparation of an act in the established form or preparation of an act in the established form;

e) preparation of proposals for filing claims or lawsuits against a medical organization for compensation for harm caused to insured persons and sanctions applied to the medical organization;

f) familiarization of the management of the medical organization with the results of medical and economic examination and examination of the quality of medical care;

g) generalization and analysis of control results, preparation of proposals for the implementation of targeted and thematic medical and economic examinations and examinations of the quality of medical care;

h) assessment of the satisfaction of insured persons with the organization, conditions and quality of medical care provided.

81. The examination of the quality of medical care in accordance with Part 7 of Article 40 of the Federal Law is carried out by a quality expert of medical care, who is a medical specialist with a higher professional education, a certificate of specialist accreditation or a specialist certificate, work experience in the relevant medical specialty of at least 10 years and trained in expert activities in the field of compulsory health insurance, included in the territorial register of experts in the quality of medical care (clause 84 of this section).

An expert in the quality of medical care conducts an examination of the quality of medical care in his/her main medical specialty, as determined by a diploma, a certificate of accreditation of a specialist, or a specialist certificate.

When conducting an examination of the quality of medical care, the quality of medical care expert has the right to maintain anonymity/confidentiality.

82. The main task of the quality of medical care expert is to conduct an examination of the quality of medical care in order to identify defects in medical care, including assessing the correctness of the choice of a medical organization, the degree of achievement of the planned result, establishing cause-and-effect relationships of identified defects in medical care, drawing up an expert opinion and recommendations for improvement quality of medical care in compulsory health insurance.

The quality of medical care expert is not involved in the examination of the quality of medical care in a medical organization with which he has an employment or other contractual relationship, and is obliged to refuse to conduct an examination of the quality of medical care in cases where the patient is (was) his relative or patient, in treatment in which a quality of care expert was involved.

83. An expert on the quality of medical care when conducting an examination of the quality of medical care:

a) uses medical documents containing a description of the diagnostic and treatment process, and, if necessary, examines patients;

b) provides information about the regulatory documents used (procedures for the provision of medical care and standards of medical care, clinical protocols, methodological recommendations) at the request of officials of the medical organization in which the examination of the quality of medical care is carried out;

c) complies with the rules of medical ethics and deontology, maintains medical confidentiality and ensures the safety of medical documents received for temporary use and their timely return to the organizer of the examination of the quality of medical care or to a medical organization;

d) when conducting a face-to-face examination of the quality of medical care (clause 36 of Section V of this Procedure) discusses with the attending physician and the management of the medical organization the preliminary results of the examination of the quality of medical care.

(paragraph "d" as amended by the Order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144)

84. The territorial register of medical care quality experts contains information about medical care quality experts who carry out examination of the quality of medical care as part of control in a constituent entity of the Russian Federation, and is a segment of the unified register of medical care quality experts.

The territorial register of medical care quality experts is maintained by territorial compulsory health insurance funds in accordance with clause 9 of part 7 of article 34 of the Federal Law on the basis of uniform organizational, methodological, software and technical principles.

Responsibility for violations in the maintenance of the territorial register of medical care quality experts lies with the director of the territorial compulsory health insurance fund.

In accordance with clause 11 of part 8 of Article 33 of the Federal Law, the Federal Compulsory Medical Insurance Fund maintains a unified register of medical care quality experts, which is a collection of electronic databases of territorial registers of medical care quality experts.

Annex 1

Act * of medical and economic control

Heading part:
Act number, date of its preparation.
Name of the medical insurance organization. Name of the medical organization.
Account register number, period for which it was provided.

Content part
Characteristics of the register of medical care provided: the number of medical services provided, the total cost of medical services provided for payment.
Statement of compliance (non-compliance) of invoice data with the register of medical care provided.
Statement of compliance (non-compliance) of the tariffs indicated in the register of medical care provided with the approved tariffs.
Statement of compliance (non-compliance) of the types and profiles of medical care provided with the license of the medical institution.
Results of automated medical and economic control: the number of identified records containing information about defects in medical care/violations in the provision of medical care and their cost.
Interpretation of identified defects in medical care/violations in the provision of medical care (in accordance with the List of grounds for refusal (reduction) of payment for medical care (Appendix 8 to this Procedure) indicating the declared amount for payment (can be presented in tabular form).
The amount excluded from payment based on the results of medical and economic control.
The amount of financial sanctions for defects in medical care/violations in the provision of medical care if a report is filled out using this form based on the results of repeated medical and economic control conducted by the territorial compulsory health insurance fund.
The total amount accepted for payment.

Certification part
Position, signature of the employee who carried out the medical and economic control.
Position, signature of the responsible person of the medical insurance organization (territorial compulsory health insurance fund) approving the Act.
Position, signature of the head of the medical organization who has read the Act.

__________________________________

* This form is also used to fill out a report when conducting repeated medical and economic control.

Register of acts of medical and economic control No. ___ dated __________
Period ________________ 201_ - ________________ 201_
Type of medical and economic control: ________ (primary - 1, repeated - 2)
Name and code of the medical organization (TF) that received invoices from the medical organization

Name and territory code of the location of the CMO (TF)
____
Name, location and code of the medical organization that provided
check ______________________________________________________________________
Code _______________________________________________________________________
Registers of invoices for medical services were provided for analysis,
provided to insured persons.
In total, invoices were provided in the amount of ___________________________________ rubles.
Invoices provided for medical and economic control include:
For inpatient medical care:
	account(s) _________ account registers ___________
	______________ in the amount of _______________________ rub.
For medical care provided in a day hospital:
	______________ account registers
	______________ invoices _________ in the amount of ___________ rubles.
For outpatient medical care (including dental and paraclinical services):
account(s) _________ account registers _________
in the amount of ___________________ rub.
1. Agreed upon payment of all:
Accounts ____________ in the amount of ____________ rubles.
registers of accounts in the amount of: _____________________ rub.

for honey assistance in a day hospital in the amount of: _________ rub. _______ accounts
for outpatient medical care. assistance in the amount of: _____ rub. ____ accounts
2. It has not been agreed upon to pay registers of invoices in the amount of: __________ rub.
Including: for inpatient medical care in the amount of: _____ rub. ____ accounts
for medical care in a day hospital in the amount of: _____ rub. ____ accounts
for outpatient medical care in the amount of: __________ rub.
______ accounts
for exceeding the agreed volumes of medical services in the amount of: ______ rub.
2.1. _______ invoices in the amount of _________ rubles are not subject to payment.
2.1.1. for inpatient medical care in the amount of: ______ rub. ____ accounts

2.1.2. for medical care in a day hospital in the amount of: __________ rub. ____ accounts

2.1.3. for outpatient medical care in the amount of: ___ rub. ______ accounts

2.2. Deleted

2.3. Not accepted for payment due to exceeding the agreed volumes of medical services by a total amount of _________________ rubles:

Department of Defense	Branch code	The period in which the agreed volumes were exceeded (quarter)	The amount of excess of the agreed volumes of medical services (c/d., visits, UET)	Amount not payable due to exceeding agreed volumes	Amount not accepted for payment due to exceeding the agreed volumes	Including: before repeated IEC	Amount withheld in the current month	Amount to be withheld in the subsequent period
1	2	3	4	5	6	7	8	9

Date of provision of CMO (TF) invoices by a medical organization
"__" ____________ 201_
Date of verification of accounts (registers) "__" _____________ 201_
Specialist (full name and signature) ________________________________

Appendix 3

Certificate of medical and economic examination of an insured event
No. ___ dated __________

1. Date of examination ________________________________________________

2. Last name, first name, patronymic of the expert specialist _________________________________

___________________________________________________________________________

3. Name of the inspection organization _____________________________________

___________________________________________________________________________

4. Name of the medical organization _____________________________________

___________________________________________________________________________

5. Medical bill number __________________________________________

6. Compulsory health insurance policy number ___________________________

___________________________________________________________________________

7. Medical card number (outpatient or inpatient)

___________________________________________________________________________

8. Final (clinical) diagnosis of the underlying disease ___________________

___________________________________________________________________________

9. Diagnosis of concomitant disease ________________________________________________

___________________________________________________________________________

10. Duration of treatment from _________________________ to _____________________________

11. Cost of treatment ________________________________________________________________

12. Duration of the disease _________________________________________________

13. Last name, first name, patronymic of the attending physician ____________________________________

14. Additionally, the following accounting and reporting documentation was checked ____________

___________________________________________________________________________

Conclusion of a specialist expert on the validity of volumes
medical services provided for payment and their compliance
records in primary medical and accounting documentation
medical organization
(including a short list of identified deficiencies)

___________________________________________________________________________

CONCLUSIONS:

Not payable (amount, defect/violation code) fine (amount, code

defect/violation) __________________________________________________________

Payable _______________________

Medical organization ___________________________________________________

Account amount ____________________________________________________________

1. Number of verified medical documentation _____ (medical records

outpatient/inpatient, other accounting and reporting documentation)

2. A discrepancy between the invoice and records was revealed in the amount of _______________ rubles.

3. Defects in medical care/irregularities in the provision of medical care were identified

help: _______________________________________

All identified defects in medical care/violations are indicated below.

when providing medical care in accordance with the List of grounds for

refusal (reduction) of payment for medical care (Appendix 8 to this

Order) indicating a specific amount.

The total non-payable amount is _____ rub. Fine in the amount of ______ rub. Total

payable: _____ rub.

Total payable: ______________ rub.

Specialist-expert economist of a medical insurance organization _______________
___________________

"__" __________ 201_

Head of a medical organization ________________

M.P.

Appendix 5

Certificate of examination of the quality of medical care (targeted)
No. ___ dated __________

"__" __________ 201_

Expert in the quality of medical care

___________________________________________

(full name of the expert)

on behalf of

___________________________________________________________________________

(name of sending organization)

Order No. ___________________________________

in connection with _________________________________________________________________

(reason for verification - complaint, claim, etc.)

a targeted examination of the quality of medical care was carried out in order to

place of work ______________________________________________________________

Place of medical care

_______________________________________________________________________

(name of medical organization, department)

FULL NAME. attending physician _________________________________________________

Medical record (outpatient, inpatient) of the patient, others

accounting and reporting documents

№ ________________

Period of medical care:

from "__" __________ 201_ to "__" ___________ 201_

Diagnosis established by a medical organization

___________________________________________________________________________

BRIEF EXPERT OPINION

(prepared on the basis of expert opinion):

help

___________________________________________________________________________

conclusions

___________________________________________________________________________

Recommendations

___________________________________________________________________________

Unpaid (bed days, patient days, visits):

___________________________________________________________________________

Fine in the amount of ___ rub.

Based on the results of the audit, a review of this case was carried out with management
medical organization.

Signature of a medical care quality expert ______________________________

Signature of a representative of the medical insurance organization (territorial

compulsory health insurance fund) ___________________________________

Signature of a representative of a medical organization ___________________________________

M.P.

Compiled in two copies

Appendix 6

Act
examination of the quality of medical care (planned)
No. _______ dated __________________

V _________________________________________________________________________

(name of medical organization, address)

in accordance with the agreement dated ____________ No. ________

Organization that carried out the inspection: ________________________________________

FULL NAME. medical quality expert

help (or identification number): _____________________________________

Checked period: from ___________ to __________

Date of examination of the quality of medical care: ___________________

Identified defects in medical care/irregularities in the provision of medical care
assistance (in accordance with the List of grounds for refusal (reduction) of payment
medical care - Appendix 8 to this Procedure):

Appendix 7

Re-examination report * based on the results of medical and economic
examination/examination of the quality of medical care
(Underline whatever applicable)
No. ___ dated __________

Based on the order of the director of the territorial mandatory fund
health insurance ________________ (name)

from "__" ________________ 201_ No. ____________

Experts (specialist-expert/expert of quality of medical care -

Underline as necessary): ____________ (position) _____________ (full name

____________ (position) __________________ (full name)

a re-examination was carried out based on the results of MEE/ECMP (underline as appropriate),

carried out by the CMO _________________________________________________________________

name of the SMO

CMO location address _________________________________________________

Date of inspection ___________________________________________________

The audit was carried out for the period from "__" ________ 201_ to "__" ______ 201_.

in a medical organization

___________________________________________________________________________

name of medical organization, city, district

Accepted for payment ___________ bills for treated insured persons

of which: inpatient care - ______________________,

medical care in a day hospital - _________________,

outpatient care - ______________________.

The medical examination was carried out by MEE/ECMP (underline as appropriate) in _______________ cases (___%):

of which: inpatient care - _____________________________ cases (___%),

medical care in a day hospital - _________________ cases (___%),

outpatient care - ______________________ cases (___%).

At the same time, the CMO identified ________________ cases (___%) of violations committed

when providing medical care to insured persons.

1. A re-examination of _____________ cases (___%) was carried out.

2. Upon re-examination of __________ cases recognized as satisfactory by the CMO,
the expert opinion of TFOMS specialists coincided with the expert opinion

SMO in ___________ cases (___%), namely:

2.1. In _________________ cases (___%), specialists of the territorial compulsory health insurance fund identified violations committed by the medical organization, but not identified by the health insurance company.

- No., compulsory health insurance policy no., treatment period, number of bed days (visits, services, UET), tariff for a completed case, diagnosis (main, accompanying), category (working, non-working);

Defects in medical care/violations in the provision of medical care in accordance with Appendix 8 to this Procedure, committed by the medical organization, but not identified by the health insurance company;

The expert opinion of the specialists of the territorial compulsory health insurance fund is formulated in accordance with the agreement with the health insurance organization, indicating the item number of the list of violations and the amounts of financial sanctions, the name of the violations.

The invoice amount is ___________ rub., the amount of financial sanctions is _______ rub.

3. A re-examination of _______ cases was carried out with violations identified by the CMO in the medical organization and the provision of medical care to insured persons.

In ________ cases (___%), the expert opinion of the CMO coincided with the expert opinion of specialists from the territorial compulsory health insurance fund, namely:

3.1. In ___________ cases (___%), specialists of the territorial compulsory health insurance fund identified violations committed by medical insurance specialists during MEE/ECMP (underline as appropriate).

Description of a specific case of identified violation includes:

- No., compulsory health insurance policy no., treatment period, number of bed days (visits, services, UET), tariff, diagnosis (main, accompanying), category (working, non-working);

The essence of the violation identified by the CMO;

An expert opinion adopted by the CMO indicating the amount of underpayment;

A violation committed by the CMO during the organization and conduct of MEE/ECMP.

Account amount ____________ rub.

The amount unreasonably withheld by the medical organization from the medical organization is _____ rub.

The amount of financial sanctions is ___________ rub.

4. Conclusions: The expert opinion of the health insurance organization and the territorial compulsory health insurance fund coincided in _________ cases (___%), violations were identified by the health insurance organization in organizing and conducting MEE/ECMP (underline as appropriate) in _________ cases (___%), including types of violations indicating the number and amounts.

5. Proposals: The unreasonably withheld amount in the amount of ________ rubles is subject to restoration by the medical organization by a separate payment order.

Financial sanctions in the amount of _________ rubles are subject to transfer at the expense of the health insurance organization’s own funds to the TFOMS account.

An amount in the amount of ___ rubles is subject to return by the medical organization to the budget of the territorial compulsory health insurance fund.

______________________________________

Notes: * re-examination.

Appendix 8

List of grounds for refusal to pay for medical care (reduction of payment for medical care)

Section 1. Violations limiting the availability of medical care for insured persons
1.1.	Violation of the rights of insured persons to receive medical care in a medical organization, including:
1.1.1.	to choose a medical organization from medical organizations participating in the implementation of the territorial compulsory health insurance program;
1.1.2.	to choose a doctor by submitting an application personally or through your representative addressed to the head of the medical organization:
1.1.3.	violation of the conditions for the provision of medical care, including waiting periods for medical care provided as planned.
1.2.	Unreasonable refusal to insured persons to provide medical care in accordance with the territorial compulsory medical insurance program, including:
1.2.1.
1.2.2.	resulting in harm to health, or creating a risk of progression of an existing disease, or creating a risk of a new disease;
1.3.	Unreasonable refusal to insured persons to provide free medical care in the event of an insured event outside the territory of the constituent entity of the Russian Federation in which the compulsory health insurance policy was issued, in the amount established by the basic compulsory health insurance program, including:
1.3.1.	not causing harm to health, not creating a risk of progression of an existing disease, not creating a risk of developing a new disease:
1.3.2.	resulting in harm to health, or creating a risk of progression of an existing disease, or creating a risk of a new disease.
1.4.	Collection of fees from insured persons (as part of voluntary health insurance or in the form of paid services) for medical care provided under the territorial compulsory health insurance program.
1.5.	The patient’s purchase of medicines and medical products during his stay in the hospital as prescribed by a doctor, included in the “List of Vital and Essential Medicines”, “Inpatient Care Form”, agreed upon and approved in the prescribed manner; based on standards of medical care.
Section 2. Lack of awareness of the insured population
2.1.	Lack of an official website of a medical organization on the Internet.
2.2.	Absence of the following information on the official website of a medical organization on the Internet:
2.2.1.
2.2.2.	on the conditions for the provision of medical care established by the territorial program of state guarantees for the provision of free medical care to citizens of the Russian Federation, including the waiting period for medical care:
2.2.3.	about the types of medical care provided;
2.2.4.
2.2.5.
2.2.6.
2.3.	Lack of information stands in medical organizations.
2.4.	Absence of the following information on information stands in medical organizations:
2.4.1.	about the operating hours of the medical organization;
2.4.2.	on the conditions for the provision of medical care established by the territorial program of state guarantees for the provision of free medical care to citizens of the Russian Federation, including the waiting period for medical care;
2.4.3.	about the types of medical care provided in this medical organization;
2.4.4.	on indicators of accessibility and quality of medical care;
2.4.5.	on the list of vital and essential medications used in the provision of inpatient medical care, as well as ambulance and emergency medical care free of charge;
2.4.6.	on the list of medicines dispensed to the population in accordance with the list of population groups and categories of diseases, for the outpatient treatment of which medicines and medical products are dispensed according to doctors' prescriptions free of charge, as well as in accordance with the list of population groups, for the outpatient treatment of which medicines are dispensed according to doctors' prescriptions with a 50 percent discount from free prices.
Section 3. Defects in medical care / violations in the provision of medical care
3.1.	Cases of violation of medical ethics and deontology by employees of a medical organization proven in accordance with the established procedure (established based on requests from insured persons).
3.2.	Failure to perform, untimely or improper performance of diagnostic and (or) therapeutic measures and surgical interventions necessary for the patient in accordance with the procedure for providing medical care and (or) standards of medical care:
3.2.1.	not affecting the health status of the insured person;
3.2.2.	leading to an extension of the treatment period beyond the established ones (except for cases of refusal of the insured person from medical intervention and (or) lack of written consent to treatment, in cases established by the legislation of the Russian Federation);
3.2.3.	leading to a deterioration in the health of the insured person, or creating a risk of progression of an existing disease, or creating a risk of a new disease (except for cases of refusal of the insured person to receive treatment in accordance with the established procedure);
3.2.4.	leading to disability (except for cases of refusal of the insured person to receive treatment in accordance with the established procedure);
3.2.5.	leading to death (except for cases of refusal of the insured person to receive treatment in accordance with the established procedure).
3.3.	Performing unindicated, unjustified from a clinical point of view, activities not regulated by the standards of medical care:
3.3.1.	leading to an extension of the treatment period, an increase in the cost of treatment in the absence of negative consequences for the health of the insured person;
3.3.2.	leading to a deterioration in the health of the insured person, or creating a risk of progression of an existing disease, or creating a risk of a new disease (except for cases of refusal of the insured person to receive treatment in accordance with the established procedure).
3.4.	Premature, from a clinical point of view, cessation of treatment measures in the absence of a clinical effect (except for cases of refusal of treatment formalized in the prescribed manner).
3.5.	Repeated justified request by the insured person for medical help for the same disease within 30 days from the date of completion of outpatient treatment and 90 days from the date of completion of inpatient treatment, due to the lack of positive dynamics in the state of health, confirmed by a targeted or planned examination (except in cases staged treatment).
3.6.	Violation of continuity of treatment due to the fault of a medical organization (including untimely transfer of a patient to a higher-level medical organization), which led to an extension of the treatment period and (or) a deterioration in the health status of the insured person.
3.7.	Hospitalization of an insured person without medical indications (unreasonable hospitalization), medical care to whom could have been provided to the established extent in an outpatient setting, in a day hospital.
3.8.	Hospitalization of an insured person whose medical care should be provided in a hospital of a different profile (non-core hospitalization), except in cases of hospitalization for emergency reasons.
3.9.	Unreasonable extension of treatment time due to the fault of a medical organization, as well as an increase in the number of medical services, visits, bed days, not related to diagnostic, therapeutic measures, and surgical interventions within the framework of the standards of medical care.
3.10.	A repeated visit to a doctor of the same specialty on the same day when providing outpatient medical care, with the exception of a repeat visit to determine indications for hospitalization, surgery, or consultations in other medical organizations.
3.11.	The action or inaction of medical personnel that led to the development of a new disease of the insured person (the development of an iatrogenic disease).
3.12.	Unreasonable prescription of drug therapy; simultaneous prescription of drugs that are synonymous, analogues or antagonists in terms of pharmacological action, etc., associated with a risk to the patient’s health and/or leading to an increase in the cost of treatment.
3.13.	Failure, through the fault of a medical organization, to perform a mandatory pathological autopsy in accordance with current legislation.
3.14.	The presence of discrepancies between clinical and pathological diagnoses of categories 2-3.
Section 4. Defects in the preparation of primary medical documentation in a medical organization
4.1.	Failure to provide primary medical documentation confirming the fact of provision of medical care to the insured person in a medical organization without objective reasons.
4.2.	Defects in the preparation of primary medical documentation that impede the examination of the quality of medical care (inability to assess the dynamics of the health status of the insured person, the volume, nature and conditions of medical care).
4.3.	Absence in the primary documentation of: informed voluntary consent of the insured person to medical intervention or refusal of the insured person to undergo medical intervention and (or) written consent to treatment, in cases established by the legislation of the Russian Federation.
4.4.	Presence of signs of falsification of medical documentation (additions, corrections, “inserts”, complete re-registration of the medical history, with deliberate distortion of information about the diagnostic and therapeutic measures carried out, the clinical picture of the disease).
4.5.	The date of medical care recorded in the primary medical documentation and the register of accounts does not correspond to the doctor’s timesheet (providing medical care during vacation, study, business trips, weekends, etc.).
4.6.	Inconsistency between the primary medical documentation data and the account registry data, including:
4.6.1.	inclusion in the invoice for payment of medical care and the register of accounts of visits, bed days, etc., not confirmed by primary medical documentation;
4.6.2.	discrepancy between the terms of treatment, according to the primary medical documentation, of the insured person and the terms specified in the account register;
Section 5. Violations in the preparation and presentation of invoices and registers of invoices for payment
5.1.	Violations related to the preparation and presentation of invoices and invoice registers for payment, including:
5.1.1.	presence of errors and/or inaccurate information in the account details:
5.1.2.	the invoice amount does not correspond to the total amount of medical care provided according to the invoice register;
5.1.3.	the presence of blank fields in the register of accounts that are required to be filled out;
5.1.4.	incorrect filling in the fields of the account register;
5.1.5.	the declared amount for the account register item is not correct (contains an arithmetic error);
5.1.6.	the date of medical care in the billing register does not correspond to the reporting period/payment period.
5.2.	Violations related to determining whether the insured person belongs to a medical insurance organization:
5.2.1.	inclusion in the register of accounts of cases of medical care provided to a person insured by another medical insurance organization;
5.2.2.	introduction of inaccurate personal data of the insured person into the register of accounts, leading to the impossibility of his complete identification (errors in the series and number of the compulsory medical insurance policy, address, etc.);
5.2.3.	inclusion in the register of accounts of cases of medical care provided to an insured person who received a compulsory medical insurance policy in the territory of another constituent entity of the Russian Federation;
5.2.4.	the presence in the account register of outdated data on insured persons;
5.2.5.	inclusion in the registers of accounts of cases of medical care provided to categories of citizens not subject to compulsory medical insurance in the territory of the Russian Federation.
5.3.	Violations associated with inclusion in the register of medical care that is not included in the territorial compulsory medical insurance program:
5.3.1.	Inclusion in the register of accounts of types of medical care that are not included in the Territorial Compulsory Medical Insurance Program;
5.3.2.	Presentation for payment of cases of medical care in excess of the distributed volume of medical care established by the decision of the commission for the development of the territorial program;
5.3.3.	Inclusion in the register of accounts of cases of medical care that are subject to payment from other sources of financing (serious accidents at work, paid by the Social Insurance Fund).
5.4.	Violations related to the unreasonable application of tariffs for medical care:
5.4.1.	Inclusion in the register of accounts of cases of medical care at tariffs for payment of medical care that are not included in the tariff agreement;
5.4.2.	Inclusion in the register of accounts of cases of medical care at tariffs for payment of medical care that do not correspond to those approved in the tariff agreement.
5.5.	Violations related to the inclusion of unlicensed types of medical activities in the register of accounts:
5.5.1.	Inclusion in the register of accounts of cases of medical care for types of medical activities that are not included in the current license of the medical organization;
5.5.2.	Providing registers of accounts in case of termination of the license of a medical organization in accordance with the established procedure:
5.5.3.	Providing invoices for payment of registers in case of violation of licensing conditions and requirements for the provision of medical care: these licenses do not correspond to the actual addresses of the licensed type of activity carried out by the medical organization, etc. (upon detection, as well as on the basis of information from licensing authorities).
5.6.	Inclusion 8 of the register of accounts of cases of medical care provided by a specialist who does not have a certificate or certificate of accreditation in the profile of medical care.
5.7.	Violations related to repeated or unjustified inclusion in the register of medical care accounts:
5.7.1.	Invoice registry item previously paid (re-invoicing for medical care cases that were previously paid);
5.7.2.	Duplication of medical care cases in one registry;
5.7.3.	The cost of a separate service included in the invoice is taken into account in the tariff for payment of medical care for another service, also presented for payment by the medical organization;
5.7.4.	The cost of the service is included in the standard of financial support for payment of outpatient medical care for the assigned population insured in the compulsory medical insurance system.
5.7.5.	Inclusions in the register of medical care accounts: - outpatient visits during the period of the insured person’s stay in a 24-hour hospital (except for the day of admission and discharge from the hospital, as well as consultations in other medical organizations within the framework of the standards of medical care); - patient-days of stay of the insured person in a day hospital during the patient’s stay in a 24-hour hospital (except for the day of admission and discharge from the hospital, as well as consultations in other medical organizations).
5.7.6.	Inclusion in the register of accounts of several cases of provision of inpatient medical care to an insured person in one payment period with the intersection or coincidence of treatment periods.

the following reasons: 1. Compulsory health insurance policy number ________________________ Settlement amount ________________________________ Justification for disagreement _________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 2. 3. In total, I consider the amount of mutual settlement for ___ insured to be unreasonable
person(s) for the total amount of __________________ rubles. Applications: 1) Materials of internal and departmental quality control
medical care on ______ sheet(s);

Appendix 10

No.	Compulsory medical insurance policy number	Source of information (eg number medical card amb./stationary sick)	Dates of access		ICD code	Paid for medical services	Medical defect code assistance/impairment	Size mutual settlement	Service mark
No.	Compulsory medical insurance policy number		Start	end	ICD code	Paid for medical services	Medical defect code assistance/impairment	Size mutual settlement	Service mark
1	2	3	4	5	6	7	8	9	10




Total							-		-

Appendix 11

Expert opinion
(protocol for assessing the quality of medical care)

Name of the inspection organization _____________________________________________

Medical record (outpatient/inpatient) of patient No. ___, attending physician _____________

Compulsory health insurance policy number _____________ Gender _________

Date of Birth _____________________

Address of the insured person ________________________________________________

Name of medical organization _____________________________________________

Invoice No. _______ dated "__" _______________________ 201_

Duration of treatment (days) total ___________ Cost total _______ rub.

department _______________________________________ from ____ to ____, k/d. ____;

Medical care quality expert _____________________________________________

Date of examination of the quality of medical care: "__" ______ 201_

Admission: emergency, planned.

Case outcome: recovery, improvement, no change, deterioration, death,
unauthorized departure, transferred (directed) to hospitalization (where), other

___________________________________________________________________________

Operation _____________________, date "__" ____________________ 201_

Final clinical diagnosis:

___________________________________________________________________________

Pathological diagnosis:

basic __________________________________________________________________

___________________________________________________________________________

complication ________________________________________________________________

___________________________________________________________________________

accompanying ______________________________________________________________

___________________________________________________________________________

I. COLLECTION OF INFORMATION (questioning, physical examination, laboratory tests)

and instrumental studies, specialist consultations, consultation)

___________________________________________________________________________

Justification of the negative consequences of errors in information collection:

___________________________________________________________________________

II. DIAGNOSIS (wording, content, time of presentation)

basic __________________________________________________________________

___________________________________________________________________________

complication ________________________________________________________________

___________________________________________________________________________

accompanying ______________________________________________________________

___________________________________________________________________________

Justification of the negative consequences of errors in diagnosis:

___________________________________________________________________________

III. TREATMENT (surgical, including obstetrics, medication,

other types and methods of treatment)

___________________________________________________________________________

Justification of the negative consequences of errors in treatment:

___________________________________________________________________________

IV. CONTINUITY (reasonableness of admission, duration of treatment,
translation, content of recommendations)

___________________________________________________________________________

Justification of the negative consequences of errors in continuity of treatment:

___________________________________________________________________________

CONCLUSION of an expert on the quality of medical care:

___________________________________________________________________________

THE MOST SIGNIFICANT ERRORS THAT AFFECTED THE OUTCOME OF THE DISEASE:

___________________________________________________________________________

Medical care quality expert:	______________________________________
	signature, full name, date of signing

M.P.

If defects approved by FFOMS Order No. 230 are identified, financial sanctions may be applied to the medical organization.

But this fact is not enough to obtain compensation for damages from the employee who directly provided such assistance.

↯ More articles in the magazine

The employer has the right to apply disciplinary sanctions in accordance with labor legislation, and the Labor Code of the Russian Federation does not provide for such a measure as a fine.

The possibility of deducting amounts from wages for improper performance of job duties is also not provided.

The court may decide to compensate for material damage caused by an employee of a medical organization if it proves that there are all legal grounds for this.

Imposition of fines: scope of FFOMS order N 230

Fifth group

The fifth group is violations due to the fault of the medical organization of continuity of treatment, unreasonable or non-core hospitalization of the insured person. The basis for such an expert conclusion would be a violation of the procedures for providing medical care or the criteria for hospitalization.

Important! Non-compliance with hospitalization criteria includes the absence of medical indications for staying in a 24-hour hospital and hospitalization in an organization that does not have the appropriate license

Sixth group of defects

The sixth group of defects is the development of iatrogenic disease. Iatrogenesis is considered to be a deterioration in health or the emergence of a new disease caused by any medical influence.

Seventh group

The seventh group is the failure to provide, without objective reasons, primary medical documentation confirming the provision of medical care. Exceptions are cases of seizure of documentation by authorized bodies or at the official request of the insured person or his representative.

Eighth group

The eighth group - design defects that impede the examination of the quality of medical care and create the impossibility of assessing the dynamics of the health status of the insured person, the volume, nature and conditions of the provision of medical care.

Important! Defects in the preparation of primary medical documentation are identified when the approved rules for its preparation are violated

Identification of defects in medical care (standards of medical care are violated) provides grounds for the insurance company to apply financial sanctions provided for in the contract for the provision and payment of medical care. This, in turn, can be considered as material damage to a medical organization.

Since the identified defects are a direct consequence of the actions of specific employees, the administration of the medical institution has a desire to recover from them the amount of damage caused. Is it possible?

Within the meaning of paragraph 13 of Art. 2 of Federal Law No. 323-FZ of November 21, 2011, a medical worker has an employment relationship with a medical organization. He is a subject of labor law, and the implementation of medical activities is his labor duty.

Important! For improper performance of job duties, the employer has the right to apply to the employee only those disciplinary sanctions that are provided for by labor legislation.

By virtue of Part 1 of Art. 192 of the Labor Code of the Russian Federation for failure to perform or improper performance due to the fault of an employee of the labor duties assigned to him, the employer has the right to apply:

Comment.
Rebuke.
Dismissal for appropriate reasons. This list is exhaustive.

According to Part 2 of Art. 192 of the Labor Code of the Russian Federation Federal laws, charters and regulations on discipline for certain categories of employees may provide for other disciplinary sanctions. But currently there are no special disciplinary sanctions for medical workers.

Based on Part 4 of Art. 192 of the Labor Code of the Russian Federation does not allow the use of disciplinary sanctions not provided for by Federal laws, charters, etc.

Important! This type of liability, such as a fine, cannot be applied to medical workers, including for the provision of medical care of inadequate quality.

Otherwise, the employer’s actions may be regarded as a violation of labor legislation and other regulatory legal acts containing labor law norms.

This entails the imposition of sanctions provided for by the Code of Administrative Offenses of the Russian Federation - a warning or the imposition of an administrative fine on officials in the amount of 1 to 5 thousand rubles, on legal entities - from 30 to 50 thousand rubles.

Important! The inability to fine an employee does not mean the inability to hold him financially liable if, through his fault, the institution was subjected to financial sanctions

In accordance with Part 1 of Art. 233 of the Labor Code of the Russian Federation, financial liability of a party to an employment contract arises for damage caused to the other party to the contract as a result of culpable unlawful behavior (actions or inaction).

Liability for damage caused

By virtue of Art. 238 of the Labor Code of the Russian Federation, the employee is obliged to compensate the employer for direct actual damage caused to him.

Under direct actual damage within the meaning of Part 2 of Art. 238 of the Labor Code of the Russian Federation refers to a real decrease in the employer’s available property or a deterioration in the condition of said property, as well as the need for the employer to make expenses or excessive payments for the acquisition, restoration of property or for compensation for damage caused by the employee to third parties.

We note that on the basis of Art. 241 of the Labor Code of the Russian Federation, an employee bears financial liability for damage caused only within the limits of his average monthly earnings.

The exception is cases of full financial liability provided for in Art. 243 Labor Code of the Russian Federation:

causing damage while under the influence of alcohol, drugs or other toxic substances;
intentional causing of damage;
causing damage as a result of criminal actions established by a court verdict;
causing damage as a result of an administrative violation.

In accordance with paragraph 15 of the resolution of the Plenum of the Supreme Court of the Russian Federation dated November 16, 2006 No. 52 “On the application by courts of legislation regulating the financial liability of employees for damage caused to the employer,” damage caused by the employee to third parties should be understood as all amounts paid by the employer in damages account.

Important! An employee can be held liable only if there is a cause-and-effect relationship between his culpable behavior (action or inaction) and damage to third parties

According to paragraph 4 of the resolution of the Plenum of the Supreme Court of the Russian Federation dated November 16, 2006 No. 52, the circumstances that are essential for the correct resolution of the case of compensation for damage by the employee, the obligation to prove which rests with the employer, include:

absence of circumstances excluding the employee’s financial liability;
unlawfulness of the behavior (actions or inaction) of the harm-cauter; the employee’s guilt in causing the damage;
a causal relationship between the employee’s behavior and the resulting damage;
the presence of direct actual damage;
the amount of damage caused; compliance with the rules for concluding an agreement on full financial liability.

It is worth noting that in law enforcement practice there is a conclusion that the concept of “direct actual damage” (Part 2 of Article 238 of the Labor Code of the Russian Federation) is not identical to the concept of “loss” (Clause 2 of Article 15 of the Civil Code of the Russian Federation) and does not provide for the employee’s obligation to compensate the employer the amount of the fine paid by him for violation of current legislation by third parties.

This point of view is expressed in the resolution of the Presidium of the Court of the Khanty-Mansiysk Autonomous Okrug - Ugra dated 08.28.2015 No. 44G-37/2015, in the Appeal ruling of the Moscow City Court dated 07.24.2013 No. 11–23629/2013.

What needs to be proven

Thus, in order to hold a medical worker financially liable for improper provision of medical care, the employer must prove:

The presence of direct actual damage.
Illegality of behavior (actions or inaction) of a medical worker who causes harm.
The fault of the medical worker in causing the damage.
The presence of a cause-and-effect relationship between the employee’s behavior and the resulting damage.

Important! The greatest difficulty is proving illegality in the provision of medical care of inadequate quality, which resulted in financial sanctions against the organization

Illegal behavior - violating legal norms established by current legislation. But at present, there is no legal regulation of the provision of medical care in terms of a detailed listing of therapeutic and diagnostic measures.

It is worth noting that if the actions of medical workers contain elements of a crime (for example, provided for in Article 118 of the Criminal Code of the Russian Federation - causing grievous harm to health through negligence), then after a conviction, the employee can be held fully financially liable by the employer.

Another question that makes us think about penalties for medical workers is the ability of the administration to withhold a certain amount from the salary of an employee who has provided a paid medical service of inadequate quality.

Important! In accordance with current legislation, the employer does not have the right to withhold from the employee’s salary the amount paid for poor-quality service provided

In accordance with Part 1 of Art. 137 of the Labor Code of the Russian Federation, deductions from an employee’s salary are made only in cases provided for by the Labor Code of the Russian Federation and other federal laws. Neither the Labor Code of the Russian Federation nor other federal laws establish the possibility of deductions from wages associated with improper performance of work duties by an employee.

Thus, the Labor Code of the Russian Federation and other regulatory legal acts do not provide for the possibility of recovering from an employee the amounts of financial sanctions applied to the employer. This applies to both fines for health workers and deductions from wages.

Based on the system in force in the organization, the employer has the right to deprive the employee of incentive payments (or part thereof). This is possible if the employee fails to meet the indicators and conditions for calculating incentive payments.

Please note that it is inappropriate to use the term “fine” in local regulations. When challenging regulatory legal acts, the court may recognize the “fine” as identical to the adjustment coefficient of the incentive payment, which corresponds to the indicators and quality assessment criteria established in the organization (see the Appeal ruling of the Altai Regional Court dated 09.09.2015 in case No. 33–8414/2015 ).

Order of the Federal Compulsory Health Insurance Fund dated February 22, 2017 No. 45 “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230” (not entered into force)

In accordance with Chapter 9 of the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Health Insurance in the Russian Federation” (Collected Legislation of the Russian Federation, 2010, No. 49, Art. 6422; 2011, No. 49, Art. 7047; 2012, No. 49, Art. 6758; 2013, No. 27, Art. 3477; No. 48, Art. 6165; 2016, No. 1, Art. 52) and in order to improve the organization and control of volumes, timing, quality and conditions of provision medical assistance under compulsory health insurance I order:

Introduce changes to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230 (registered by the Ministry of Justice of the Russian Federation on January 28, 2011, registration No. 19614) as amended by order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144 (registered by the Ministry of Justice of the Russian Federation on December 9, 2011, registration No. 22523), by order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 No. 130 (registered with the Ministry of Justice of the Russian Federation on July 27, 2015, registration No. 38182), by order of the Federal Compulsory Medical Insurance Fund dated December 29, 2015 No. 277 (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number No. 40813), according to the appendix to this order.

Application
to the order of the Federal Fund
compulsory health insurance
dated February 22, 2017 No. 45

Changes made to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230

1. In paragraph 10, the words “(except for control when making payments for medical care provided to insured persons outside the constituent entity of the Russian Federation on the territory of which the compulsory medical insurance policy was issued)” should be deleted.

3. In paragraph 17, the words “determined by the plan of inspections of medical organizations by medical insurance organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” are deleted.

4. Paragraph one of paragraph 19 should be stated as follows:

"19. Based on the results of a planned or targeted medical and economic examination, a specialist expert draws up a medical and economic examination report in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory health insurance fund.

5. In paragraph 21, after the words “carried out by verification,” add the words “(including using an automated system).”

a) the words “determined by the plan of inspections by medical insurance organizations of medical organizations, agreed upon by the territorial compulsory health insurance fund in accordance with paragraph 51 of this Procedure, and” shall be deleted.

b) replace the number “0.8” with the number “0.5”.

8. In subparagraph “a” of paragraph 33, after the words “average duration of treatment,” add the words “shortened or extended duration of treatment.”

9. In subparagraph “b” of paragraph 34, the words “divided by age, gender and other characteristics” should be deleted.

10. Paragraph 37 should be stated as follows:

"37. The quality of medical care expert who carried out the examination of the quality of medical care draws up an expert opinion (Appendix 11 to this Procedure) containing a description of the conduct and results of the examination of the quality of medical care, on the basis of which an act of examination of the quality of medical care is drawn up.

In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 6 to this Procedure.

If defects in medical care/violations in the provision of medical care are identified (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 5 to this Procedure.

In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of the examination of the quality of medical care, drawn up in accordance with Appendix 5 to this Procedure, are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law, the terms of the contract for the provision and payment of medical care on compulsory health insurance and a list of grounds for refusal to pay for medical care (reduction of payment for medical care) (Appendix 8 to this Procedure).

Medical insurance organizations, on the basis of examination reports on the quality of medical care, prepare proposals for improving the quality of medical care and send them to the territorial compulsory health insurance fund, attaching action plans to eliminate violations in the provision of medical care identified based on the results of the examination of the quality of medical care, submitted by medical organizations.” .

11. Paragraph 43 should be stated as follows:

8% - in a 24-hour hospital;

0.8% - with outpatient care;

b) from the number of primary examinations of the quality of medical care no less than:

0.5% - with outpatient care;

1.5% - emergency medical care outside a medical organization.

During the calendar year, all medical insurance organizations operating in the field of compulsory medical insurance must be subjected to re-examination in cases of medical care provided in all medical organizations.”

12. In paragraph 52, after the words “corresponding medical request,” add the words “including in electronic form when using an electronic medical record.”

13. Paragraph 57 should be supplemented with the following paragraph:

a) in paragraph two, after the words “and one copy,” add the words “with an action plan to eliminate violations in the provision of medical care identified as a result of the examination of the quality of medical care,”;

15. In subparagraph “b” of paragraph 66, the words “(for an insured event in which defects in medical care and/or violations in the provision of medical care were identified)” should be deleted.

a) paragraph one should be supplemented with the words “taking into account the results of consideration of the protocol of disagreement (if any) under paragraph 58 and paragraph 74 (if any) of this Procedure.”;

b) paragraph three should be supplemented with the words “exceeding the established time of arrival of emergency medical teams when providing emergency medical care;”.

18. Add paragraph 77 with the following paragraph:

“If the territorial compulsory health insurance fund at the place of insurance does not agree with the results of the medical and economic examination and/or examination of the quality of medical care, the territorial compulsory health insurance funds agree on the candidacy of a specialist expert and/or expert on the quality of medical care and the territorial fund at the place of provision of medical care carries out the corresponding examination again."

19. In Appendices 3, 5 to this Procedure, the word “(target)” should be deleted.

20. In Appendix 6 to this Procedure:

Draft Order of the Federal Compulsory Health Insurance Fund “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by Order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230” (prepared Federal Compulsory Medical Insurance Fund 12/27/2016)

Project dossier

In accordance with Chapter 9 of the Federal Law of November 29, 2010 N 326-FZ “On Compulsory Medical Insurance in the Russian Federation” (Collected Legislation of the Russian Federation, 2010, N 49, Art. 6422; 2011, N 49, Art. 7047; 2012, N 49, Art. 6758; 2013, N 27, Art. 3477; N 48, Art. 6165; 2016, N 1, Art. 52) and in order to improve the organization and control of volumes, timing, quality and conditions of provision medical assistance under compulsory health insurance

To introduce changes to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230 (registered by the Ministry of Justice of the Russian Federation on January 28, 2011, registration N 19614) as amended by order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 N 144 (registered by the Ministry of Justice of the Russian Federation on December 9, 2011, registration N 22523), by order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 N 130 (registered with the Ministry of Justice of the Russian Federation on July 27, 2015, registration N 38182), by order of the Federal Compulsory Medical Insurance Fund dated December 29, 2015 N 277 (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number N 40813) in accordance with the appendix to this order.

Application
to the order of the Federal Compulsory Medical Insurance Fund
dated "___"____________ 2016 N______

Changes,
introduced into the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230

a) subparagraph “a” should be stated as follows:

“a) repeated visits for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the moment of the previous call - when calling emergency medical services again;";

2. Paragraph one of paragraph 19 should be stated as follows:

"19. Based on the results of a planned or targeted medical and economic examination, a specialist expert draws up a medical and economic examination report (Appendices 3 and 10 to this Procedure) in two copies: one is transferred to the medical organization, one copy remains in the medical insurance organization / territorial compulsory medical fund insurance.

In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 10 to this Procedure.

In case of detection of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), a medical and economic examination report is drawn up in accordance with Appendix 3 to this Procedure."

3. In paragraph 21, after the words “carried out by verification,” add the words “(including using an automated system).”

a) subparagraph “e” should be stated as follows:

“f) repeated justified appeal for the same disease: within 15 days - when providing outpatient care, within 30 days - when re-hospitalization; within 24 hours from the moment of the previous call - when calling emergency medical services again;";

5. In paragraph 30, replace the number “0.8” with the number “0.5”.

6. In subparagraph “a” of paragraph 33, after the words “average duration of treatment,” add the words “shortened or extended duration of treatment.”

7. In subparagraph “b” of paragraph 34, the words “divided by age, gender and other characteristics” should be deleted.

8. Paragraph two of paragraph 37 should be stated as follows:

“In the absence of defects in medical care/violations in the provision of medical care (in accordance with the list of grounds for refusal to pay for medical care (reduction in payment for medical care), an examination report on the quality of medical care is drawn up in accordance with Appendix 6 to this Procedure.

In accordance with parts 9 and 10 of Article 40 of the Federal Law, the results of the examination of the quality of medical care, drawn up by the relevant act in the form established by the Federal Compulsory Health Insurance Fund (Appendix 5 to this Procedure), are the basis for applying to a medical organization the measures provided for in Article 41 of the Federal Law law, the terms of the contract for the provision and payment of medical care under compulsory health insurance and a list of grounds for refusal to pay for medical care (reduction of payment for medical care) (Appendix 8 to this Procedure).

9. Paragraph one of paragraph 43 should be stated as follows:

"43. The number of cases subjected to re-examination is determined by the number of reasons for their conduct in accordance with paragraphs 40, 41 of this Procedure, and is:

a) from the number of primary medical and economic examinations not less than:

8% - in day hospital;

3% - emergency medical care outside a medical organization;

5% - in a 24-hour hospital;

3% - in day hospital;

1.5% - emergency medical care outside a medical organization."

10. In paragraph 52, after the words “corresponding medical request,” add the words “including in electronic form when using an electronic medical record.”

11. Paragraph 57 should be supplemented with the following paragraph:

“The medical organization notifies the territorial compulsory health insurance fund if the medical insurance organization fails to submit a report within the prescribed period.”

12. Paragraph 58 should be supplemented with the following paragraph:

“The medical insurance organization reviews the protocol of disagreements within 10 working days from the date of its receipt and sends the results of the review of the protocol to the medical organization.”

13. In subparagraph “b” of paragraph 66, the words “(for an insured event in which defects in medical care and/or violations in the provision of medical care were identified)” should be deleted.

14. Paragraph three of paragraph 67 should be supplemented with the words “exceeding the established time for arrival of ambulance teams when providing emergency medical care in an emergency;”.

a) subparagraph “c” should be stated as follows:

“c) internal control materials on the disputed case.”;

b) add the following paragraph:

“The results of departmental quality control of medical care (if any) are attached to the claim.”

16. In Appendices 3, 5 to the Procedure, the word “(target)” should be deleted.

17. In Appendix 6 to the Procedure:

a) replace the word “(planned)” with the word “(consolidated)”;

b) the words “Identified defects in medical care / violations in the provision of medical care (in accordance with the List of grounds for refusal (reduction) of payment for medical care - Appendix 8 to this Procedure):" replace with the words “Checked cases of provision of medical care:”;

c) in the table, the columns “Code of medical care defect/violation”, “Subject to non-payment/reduction of payment” and “Amount of fine, rub.” exclude;

d) the words “Of these, the following were recognized as containing defects in medical care/violations in the provision of medical care: ___________________

Subject to non-payment/reduction of payment in _____ cases in the amount of ___ rubles.

Fine in ________ cases in the amount of _______________ rubles.” exclude.

18. In Appendix 8 to the Procedure:

a) clause 3.11. exclude;

b) clauses 1.1.3., 3.5., 4.2., 4.6., 4.6.1. stated in the following editions:

"1.1.3. violation of the conditions for the provision of medical care, including the waiting time for medical care provided as planned, the time of arrival of emergency medical teams.”;

"3.5. Violations in the provision of medical care (treatment defects, premature discharge, etc.), as a result of which, in the absence of positive dynamics in the state of health, the insured person required a second justified request for medical help for the same disease within 15 days from the date of completion of outpatient treatment ; re-hospitalization within 30 days from the date of completion of hospital treatment; repeat call of emergency medical services within 24 hours from the moment of the previous call.”;

"4.2. Absence in the primary medical documentation of the results of examinations, examinations, consultations with specialists, diary entries that allow assessing the dynamics of the health status of the insured person, the volume, nature, conditions of medical care and assessing the quality of the medical care provided.”;

"4.6. Inclusion in the invoice for payment of medical care/medical services in the absence of information in the medical document confirming the fact of provision of medical care to the patient.”;

"4.6.1. Incorrect application of the tariff, requiring its replacement based on the results of the examination.”

19. In Appendix 10 to the Procedure:

a) delete the words “(planned)”;

b) in the table, exclude the columns “Code of medical care defect/violation” and “Amount of mutual settlement”;

c) the words “Recognized as containing defects/violations in ___ cases in the amount of ___ rubles.

Not presented for medical and economic examination _____________.

Subject to non-payment/payment reduction in ___ cases in the amount of __ rubles.

A fine in ________ cases in the amount of ____________ rubles.” exclude.

Document overview

A draft amendment to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory medical insurance has been presented.

The cases in which a targeted medical and economic examination is carried out are specified. Thus, for repeated requests for the same disease, it will be carried out within 15 days when providing outpatient care; within 30 days - upon re-hospitalization (currently - 30 and 90 days, respectively); within 24 hours from the moment of the previous call - when calling an ambulance again.

It is proposed to reduce the volume of monthly examinations when providing medical care on an outpatient basis from 0.8% to 0.5%.

The number of cases subject to re-examination is specified.

A 10-day period is established for consideration of the protocol of disagreements by the medical insurance organization from the moment of its receipt.

It is established which forms are used to draw up reports in the event of detection of defects in medical care/violations and which forms are used in their absence.

The forms of certificates of examination of the quality of medical care are being updated. The list of grounds for refusal to pay for medical care is being revised.

2016

MHIF order No. 267 dated November 29, 2016 “On amendments to the Requirements for the structure and content of the tariff agreement, approved by order of the Federal Compulsory Health Insurance Fund dated November 18, 2014 No. 200”

2015

Order of the Compulsory Medical Insurance Fund dated January 19, 2015 No. 6 “On approval of the procedure for monitoring the quality of financial management of compulsory health insurance funds”

Order of the Compulsory Medical Insurance Fund dated April 14, 2015 No. 64 “On amendments to the Requirements for the structure and content of the tariff agreement”

order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 No. 130 “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230”

order of the Federal Compulsory Medical Insurance Fund dated December 29, 2015 No. 277 “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230”

year 2014

Order of the Compulsory Medical Insurance Fund dated November 18, 2014 No. 200 “On establishing Requirements for the structure and content of the tariff agreement”

year 2013

order of the Federal Compulsory Medical Insurance Fund dated March 18, 2013 No. 57 “On declaring the order of the Federal Compulsory Health Insurance Fund invalid”
Order of the Compulsory Medical Insurance Fund dated March 26, 2013 No. 65 “On establishing the form and procedure for reporting on wages of employees of medical organizations in the field of compulsory health insurance”
Order of the Compulsory Medical Insurance Fund dated June 14, 2013 No. 131 “On invalidating certain regulatory legal acts of the Federal Compulsory Health Insurance Fund”

year 2012

Order of the Compulsory Medical Insurance Fund dated April 16, 2012 No. 73 “On approval of regulations on control over the activities of insurance medical organizations and medical organizations in the field of compulsory health insurance by territorial compulsory health insurance funds”

2011

order of the Federal Compulsory Medical Insurance Fund dated January 14, 2011 No. 9 “On the implementation of the Decree of the Government of the Russian Federation of December 31, 2010 N 1228” (together with the “Procedure for the submission by the territorial compulsory health insurance fund of an application for financial support for expenses associated with additional medical examination of working citizens”, “ The procedure for the submission by the territorial compulsory medical insurance fund of information to complete calculations for the additional medical examination of working citizens”, “The procedure for maintaining registers of invoices for the payment of expenses associated with the additional medical examination of working citizens (Form RD-1)”)
order of the Federal Compulsory Medical Insurance Fund dated January 18, 2011 No. 10 (as amended on April 7, 2011) “On the implementation of Decree of the Government of the Russian Federation dated December 31, 2010 No. 1234” (together with the “Procedure for submission by territorial compulsory health insurance funds of applications for subsidies for medical examinations orphans and children in difficult life situations staying in inpatient institutions, and information for completing calculations for the financial support of the medical examination of orphans and children in difficult life situations staying in inpatient institutions”, “Procedure for maintaining and submitting registers of accounts to pay for the costs of medical examination of orphans and children in difficult life situations staying in inpatient institutions")
order of the Federal Compulsory Medical Insurance Fund dated January 19, 2011 No. 12 “On approval of the Procedure for conducting medical and economic examination by territorial compulsory health insurance funds of invoices submitted by medical organizations for the payment of expenses associated with the medical examination of orphans and children in difficult life situations staying in inpatient institutions”
order of the Federal Compulsory Medical Insurance Fund dated January 19, 2011 No. 13 “On approval of the Procedure for carrying out medical and economic examination by territorial compulsory health insurance funds of invoices submitted by medical organizations for the payment of expenses associated with additional medical examination of working citizens”
Order of the Compulsory Medical Insurance Fund dated August 16, 2011 No. 146 “On approval of reporting forms”
order of the Federal Compulsory Medical Insurance Fund dated August 16, 2011 No. 144 “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230”
Order of the Compulsory Medical Insurance Fund dated December 12, 2011 No. 229 “On approval of the form and procedure for submitting a report on the use of subventions provided from the budget of the Federal Compulsory Health Insurance Fund to the budgets of territorial compulsory health insurance funds”
order of the Federal Compulsory Medical Insurance Fund dated December 13, 2011 No. 230 “On approval of the Procedure for maintaining a territorial register of experts on the quality of medical care by the territorial compulsory health insurance fund and posting it on the official website of the territorial compulsory health insurance fund on the Internet”
order of the Federal Compulsory Medical Insurance Fund dated December 19, 2011 No. 235 “On approval of the procedure and form for submitting a report on the use of budget funds of the Federal Compulsory Health Insurance Fund for the purposes provided for in Part 12 of Article 51 of the Federal Law “On Compulsory Health Insurance in the Russian Federation”
order of the Federal Compulsory Medical Insurance Fund dated December 26, 2011 No. 245 “On amending the Procedure for using the funds of the normalized safety stock of the territorial compulsory health insurance fund, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 227”

2010

Order of the Compulsory Medical Insurance Fund dated January 1, 2010 No. 230 “On approval of the procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance”
order of the Federal Compulsory Medical Insurance Fund dated December 16, 2010 No. 240 (as amended on March 15, 2011) “On approval of the Procedure and form for reporting on the use of funds for the purposes of implementing regional programs for the modernization of healthcare in the constituent entities of the Russian Federation in the period 2011-2012”

2008

order of the Federal Compulsory Medical Insurance Fund dated March 14, 2008 No. 57 (as amended on January 19, 2011) “On approval of the forms and procedure for submitting reports on the use of subsidies for additional medical examinations of working citizens” (together with the “Procedure for the submission by the territorial compulsory health insurance fund of a report on the use of subsidies for conducting additional medical examinations of working citizens”, “The procedure for the submission by a medical organization of a report on the use of funds for additional medical examinations of working citizens”)
Order of the Compulsory Medical Insurance Fund dated June 3, 2008 No. 120 “On approval of the form and procedure for submitting reports on the use of subsidies for medical examination of orphans and children left without parental care in inpatient institutions”

Compulsory medical insurance news

06/08/2018: On the implementation of activities in the field of compulsory health insurance in the Vladimir region in 2019

Explanations on the procedure for submitting the Notification of activities in the field of compulsory medical insurance in the Vladimir region in 2019

04/19/2018: GBUZVO "Kameshkovo Central District Hospital" expressed gratitude to the territorial compulsory medical insurance fund of the Vladimir region

Gratitude to the TFOMS of the Vladimir region

01/24/2017: About an updated sample application for choosing (replacing) a medical insurance organization

The Federal Compulsory Health Insurance Fund sent an updated sample application for selection (replacement) of a medical insurance organization to the territorial compulsory health insurance funds

08/01/2016: On the termination of the activities of CJSC Capital Medical Insurance

On August 1, 2016, the medical insurance organization CJSC Capital Medical Insurance ceased its activities in the field of compulsory medical insurance.

05/26/2016: About the start of work of the contact center in the field of compulsory health insurance in the Vladimir region

From June 1, 2016, a contact center in the field of compulsory health insurance begins its work in the Vladimir region

Territorial Compulsory Medical Insurance Fund of the Vladimir Region

Also on topic

Interpretation of dreams about millet in dream books Why do you dream about millet

Why do you dream about mushrooms: do you want a quiet hunt?

Dream Interpretation: why do you dream of a Cart? What does it mean to see a Cart in a dream? Why do you dream of riding a white sled?

Why do you dream about space according to the dream book?

Why dream of riding a horse: the meaning of the dream

Order of the Federal Compulsory Medical Insurance Fund 230. Penalties against health workers for defects in the provision of medical care

ON RECOGNITION OF REGULATIVE LEGAL ACTS OF THE MHIF

SCROLL REVOKED REGULATIVE LEGAL ACTS OF THE FEDERAL COMPULSORY HEALTH INSURANCE FUND

Imposition of fines: scope of FFOMS order N 230

Fifth group

Sixth group of defects

Seventh group

Eighth group

Liability for damage caused

What needs to be proven

Changes made to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 No. 230

Changes, introduced into the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230

Document overview

Compulsory medical insurance news

06/08/2018: On the implementation of activities in the field of compulsory health insurance in the Vladimir region in 2019

04/19/2018: GBUZVO "Kameshkovo Central District Hospital" expressed gratitude to the territorial compulsory medical insurance fund of the Vladimir region

01/24/2017: About an updated sample application for choosing (replacing) a medical insurance organization

08/01/2016: On the termination of the activities of CJSC Capital Medical Insurance

05/26/2016: About the start of work of the contact center in the field of compulsory health insurance in the Vladimir region

SCROLL
REVOKED REGULATIVE LEGAL ACTS OF THE FEDERAL COMPULSORY HEALTH INSURANCE FUND

Changes,
introduced into the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Compulsory Health Insurance Fund dated December 1, 2010 N 230