Penalties against a health worker for defects in the provision of medical care. Penalties against a health worker for defects in the provision of medical care State budgetary institution "Kameshkovskaya Central District Hospital" expressed gratitude to the territorial fund for OMS of the Vladimir Region

26.11.2021

ON RECOGNIZING NUMBER OF NORMATIVE LEGAL ACTS OF THE MHIF

In order to bring the regulatory legal acts of the Federal Fund for Compulsory health insurance in accordance with the law Russian Federation I order:

Approve the List of Regulatory Legal Acts of the Federal Compulsory Medical Insurance Fund that have become invalid in accordance with the Appendix.

And about. directors
D.V. REIKHART

Appendix
to the Order of the MHIF
No. 230 dated October 29, 2008

SCROLL
NORMATIVE LEGAL ACTS OF THE FEDERAL FUND FOR MANDATORY HEALTH INSURANCE

1. "Settlement sheet for contributions to the Federal and territorial compulsory medical insurance funds", approved by the Compulsory Medical Insurance Fund dated 01/21/1994;

4. Order of the Compulsory Medical Insurance Fund dated March 13, 1997 N 27 "On the improvement and additional measures to develop the information system of compulsory medical insurance";

5. Order of the MHIF dated March 28, 1997 N 35 "On the organization of work with letters, complaints and proposals from citizens";

6. Order of the MHIF of May 29, 1997 N 49 "On the procedure for registering, passing and analyzing written and oral applications of citizens";

7. Order of the Compulsory Medical Insurance Fund of June 24, 1997 N 59 "On accounting for fixed assets, the procedure for their receipt and write-off in the territorial funds of compulsory medical insurance" (together with the "Methodological recommendations for accounting for fixed assets. The procedure for recording in accounting the receipt and write-off of fixed assets in territorial funds compulsory medical insurance", approved by the methodological council of the MHIF, protocol dated 31.01.1997 N 1);

8. Order of the MHIF dated 08/05/1997 N 69 "On approval of the reporting form" (together with the letter of the Ministry of Health of Russia dated 07/30/1997 N 2510 / 5757-97-23);

9. Order of the MHIF dated March 25, 1998 N 33 "On the establishment of an expert and coordinating council for informatization of the compulsory medical insurance system";

10. Order of the MHIF dated April 26, 2004 N 27 "On the organization of replication and operation of standard software";

11. "Methodological recommendations for conducting inspections intended use funds received by the territorial funds of compulsory medical insurance for the implementation of measures social support certain categories citizens to provide medicines", approved by the MHIF dated December 29, 2005 N 6790/101i;

12. Order of the MHIF dated 12.07.2005 N 69 "On making additions to the Order of the MHIF dated 05.24.2005 N 51 "On the introduction of amendments and additions to the Order of the MHIF dated 30.12.2004 N 91 "On the organization of information interaction to provide necessary medicines for certain categories citizens";

13. Order of the MHIF of 15.07.2005 N 72 "On the suspension of the Order of the MHIF of 12.07.2005 N 69 "On the introduction of amendments to the Order of the MHIF of 24.05.2005 N 51" On the introduction of amendments and additions to the Order of the MHIF of 30.12.2004 N 91 "On the organization of information interaction to provide certain categories of citizens with the necessary medicines";

14. Order of the MHIF dated September 1, 2005 N 86 "On the transition to the budget accounting chart of accounts, approved by Order of the Ministry of Finance of Russia dated August 26, 2004 N 70n";

15. Order of the MHIF of 01.09.2005 N 87 "On the transfer of compulsory medical insurance funds to the chart of accounts of budget accounting, approved by Order of the Ministry of Finance of Russia of 26.08.2004 N 70n";

16. Order of the MHIF dated October 20, 2005 N 103 "On the Order of the Government of the Russian Federation";

17. Order of the MHIF dated 07.02.2006 N 15 "On the establishment of a working group";

18. Order of the MHIF dated February 14, 2006 N 21 "On introducing amendments and additions to the Order of the MHIF dated December 28, 2005 N 29 "On approval of registers for recording funds for the implementation of social support measures for certain categories of citizens for the provision of medicines";

19. Order of the MHIF dated February 16, 2006 N 23 "On the submission budget reporting Territorial CHI Funds for 2005";

20. Order of the Compulsory Medical Insurance Fund dated September 21, 2006 N 118 "On Approval of Methodological Recommendations for the Territorial Funds of Compulsory Medical Insurance for Automated Examination of Registers of Medicines Prescriptions Dispensed to Citizens Eligible for State Social Assistance in the Form of a Set of Social Services";

21. "Methodological recommendations for the conduct of 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" by territorial MHI funds, approved by the MHIF dated 21.09.2006;

Order of the Federal Compulsory Medical Insurance Fund dated February 22, 2017 No. 45 “On Amendments to the Procedure for Organizing and Controlling the Volumes, Terms, Quality and Conditions for the Provision of Medical Assistance under Compulsory Medical Insurance, approved by Order of the Federal Compulsory Medical Insurance Fund dated December 1, 2010 No. 230” (did not enter into force)

Chapter 9 federal law dated November 29, 2010 No. 326-FZ “On Compulsory Medical 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, article 3477; No. 48, article 6165; 2016, No. 1, article 52) and in order to improve the organization and control of the volume, timing, quality and conditions of the provision of medical care under compulsory medical insurance, I order :

Amend the Procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance, approved by order of the Federal Compulsory Medical 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 by 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 ep No. 40813), according to the appendix to this order.

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

Changes to the Procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance, approved by order of the Federal Compulsory Medical 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 in whose territory the compulsory medical insurance policy was issued)" shall be excluded.

3. In paragraph 17, the words "is determined by the plan of inspections by insurance medical organizations of medical organizations, agreed by the territorial fund of compulsory medical insurance in accordance with paragraph 51 of this Procedure, and" shall be excluded.

4. Paragraph one of clause 19 shall be stated as follows:

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

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

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

b) the number "0.8" is replaced by the number "0.5".

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

9. In subparagraph "b" of paragraph 34, the words "divided by age, sex and other characteristics" shall be deleted.

10. Paragraph 37 shall be stated as follows:

37. The expert of the quality of medical care, 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.

If there are no defects in medical care / violations in the provision of medical care (in accordance with the list of grounds for refusing to pay for medical care (reducing the payment for medical care), an act of examination of the quality of medical care is drawn up in accordance with Appendix 6 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 refusing to pay for medical care (reducing the payment for medical care), an act of examination of 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 an 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 refusing to pay for medical care (reducing payment for medical care) (Appendix 8 to this Procedure).

Insurance medical organizations, on the basis of medical care quality examination certificates, prepare proposals for improving the quality of medical care and send them to the territorial compulsory health insurance fund with attached action plans to eliminate violations in the provision of medical care identified by the results of medical care quality examination submitted by medical organizations. .

11. Paragraph 43 shall be stated as follows:

8% - in a round-the-clock hospital;

0.8% - with outpatient care;

b) from the number of primary examinations of the quality of medical care, not less than:

0.5% - with outpatient care;

1.5% - emergency medical care outside a medical organization.

During the calendar year, all insurance medical organizations operating in the field of compulsory medical insurance should be subject to re-examination in cases of medical care in all medical organizations.

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

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

a) in the second paragraph, 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 an 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)” are excluded.

a) the first paragraph shall be supplemented with the words "taking into account the results of consideration of the protocol of disagreement (if any) on paragraph 58 and on paragraph 74 (if any) of this Procedure.";

b) the third paragraph shall be supplemented with the words "exceeding the established time for the arrival of ambulance teams when providing emergency medical care in an emergency form;".

18. Paragraph 77 shall be supplemented with the following paragraph:

“If the territorial compulsory medical insurance fund at the place of insurance disagrees with the results of the medical and economic examination and / or examination of the quality of medical care, the territorial compulsory medical 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 medical care re-examine appropriately.

19. In appendices 3, 5 to this Procedure, the word "(target)" shall be deleted.

20. In Appendix 6 to this Procedure:

Draft Order of the Federal Compulsory Medical Insurance Fund "On Amendments to the Procedure for Organizing and Carrying out Control over the Volumes, Terms, Quality and Conditions for the Provision of Medical Assistance under Compulsory Medical Insurance, approved by Order of the Federal Compulsory Medical 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" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2010, N 49, Art. 6422; 2011, N 49, Art. 7047; 2012, N 49, item 6758; 2013, N 27, item 3477; N 48, item 6165; 2016, N 1, item 52) and in order to improve the organization and control of volumes, terms, quality and conditions of provision medical care under compulsory health insurance

Amend the Procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance, approved by order of the Federal Compulsory Medical 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 by the Ministry of Justice of the Russian Federation on July 27, 2015, registration N 38182), by order of the Federal Compulsory Medical Insurance Fund of December 29, 2015 N 277 (registered with the Ministry of Justice of the Russian Federation on January 27, 2016, registration number ep N 40813) in accordance with the appendix to this order.

Appendix
to the order of the Federal Compulsory Medical Insurance Fund
from "___" ____________ 2016 N______

changes,
included in the Procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance, approved by order of the Federal Compulsory Medical Insurance Fund dated December 1, 2010 N 230

a) subparagraph "a" shall be stated in the following wording:

“a) repeated visits for the same disease: within 15 days - in the provision of outpatient care, within 30 days - in case of repeated hospitalization; within 24 hours from the moment of the previous call - when an ambulance is called again; ”;

2. The first paragraph of paragraph 19 shall be stated as follows:

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

If there are no defects in medical care / violations in the provision of medical care (in accordance with the list of grounds for refusing to pay for medical care (reducing the payment for medical care), an act of medical and economic expertise 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 refusing to pay for medical care (reducing the payment for medical care), an act of medical and economic expertise 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" shall be stated in the following wording:

“f) repeated justified treatment 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 an ambulance is called again; ”;

5. In paragraph 30, the number "0.8" is replaced by the number "0.5".

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

7. In subparagraph "b" of paragraph 34, the words "separated by age, sex and other characteristics" shall be deleted.

8. Paragraph two of clause 37 shall be stated as follows:

“If there are no defects in medical care / violations in the provision of medical care (in accordance with the list of grounds for refusing to pay for medical care (reducing the payment for medical care), an act of examination of 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 Medical Insurance Fund (Appendix 5 to this Procedure), are the basis for applying to the medical organization the measures provided for in Article 41 of the Federal of the law, the terms of the contract for the provision and payment of medical care under compulsory health insurance and the list of grounds for refusing to pay for medical care (reducing the payment for medical care) (Appendix 8 to this Procedure).

9. The first paragraph of paragraph 43 shall be stated as follows:

“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, and is:

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

8% - in a day hospital;

3% - emergency medical care outside a medical organization;

5% - in a round-the-clock hospital;

3% - in a day hospital;

1.5% - emergency medical care outside a medical organization.

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

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

"The medical organization notifies the territorial fund of compulsory medical insurance in case of failure of the insurance medical organization to submit an act within the prescribed period.".

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

"The insurance medical organization considers the protocol of disagreements within 10 working days from the date of its receipt and sends the results of the consideration 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)” are excluded.

14. The third paragraph of clause 67 shall be supplemented with the words "exceeding the established time for the arrival of ambulance teams when providing emergency medical care in an emergency form;".

a) subparagraph "c" shall be stated in the following wording:

"c) materials of internal control on the disputed case.";

b) add a paragraph with the following content:

“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)" shall be deleted.

17. In Appendix 6 to the Order:

a) the word "(planned)" shall be replaced by 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):” shall be replaced by the words “Checked cases 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, it was recognized as containing defects in medical care / violations in the provision of medical care: ___________________

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

Penalty for ________ cases in the amount of _______________ rub.” exclude.

18. In Appendix 8 to the Order:

a) point 3.11. exclude;

b) clauses 1.1.3., 3.5., 4.2., 4.6., 4.6.1. be presented 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 in a planned manner, the time of arrival of ambulance teams.”;

“3.5. Violations in the provision of medical care (defects in treatment, premature discharge, etc.), due to which, in the absence of positive dynamics in the state of health, it was necessary to re-substantiate the request of the insured person for medical care 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 treatment in a hospital; repeated call for an ambulance 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 of specialists, diary entries that allow assessing the dynamics of the state of health of the insured person, the volume, nature, conditions for the provision 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 that medical care was provided 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 Order:

a) the words "(planned)" shall be deleted;

b) in the table, delete the columns "Code of medical care defect/violation", "Settlement amount";

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

Not presented for medical and economic examination _____________.

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

Penalty for ________ cases in the amount of ____________ rubles. exclude.

Document overview

A draft amendment to the Procedure for organizing and monitoring the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance has been presented.

The cases in which a targeted medical and economic examination is carried out are specified. So, in case of repeated appeals for the same disease, it will be carried out within 15 days when providing outpatient care; within 30 days - with repeated 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 in the provision of medical care on an outpatient basis from 0.8% to 0.5%.

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

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

It is fixed which forms are used to draw up acts in case of detection of defects in medical care / violations and which ones - in their absence.

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

2016

order of the Compulsory Medical Insurance Fund of November 29, 2016 No. 267 “On Amendments to the Requirements for the Structure and Content of the Tariff Agreement, approved by Order of the Federal Compulsory Medical Insurance Fund of November 18, 2014 No. 200”

2015

order of the MHIF 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 MHIF dated April 14, 2015 No. 64 “On amendments to the Requirements for the structure and content of the tariff agreement”

Order of the 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 for the provision of medical care under compulsory medical insurance, approved by order of the Federal Compulsory Medical Insurance Fund dated December 1, 2010 No. 230”

Order of the Compulsory Medical Insurance Fund dated December 29, 2015 No. 277 “On Amendments to the Procedure for Organizing and Carrying out Control over the Volumes, Terms, Quality and Conditions for the Provision of Medical Assistance under Compulsory Medical Insurance, approved by Order of the Federal Compulsory Medical Insurance Fund dated December 1, 2010 No. 230”

year 2014

order of the MHIF dated November 18, 2014 No. 200 "On the establishment of Requirements for the structure and content of the tariff agreement"

year 2013

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

year 2012

order of the MHIF 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 medical insurance by territorial compulsory medical insurance funds”

2011

order of the MHIF dated January 14, 2011 No. 9 “On the implementation of Decree of the Government of the Russian Federation dated December 31, 2010 N 1228” (together with the “Procedure for submitting an application for financial support of expenses associated with additional medical examination of working citizens”, “ The procedure for the submission by the territorial fund of compulsory medical insurance of information to complete the calculations for the additional medical examination of working citizens”, “The procedure for maintaining registers of invoices for payment of expenses associated with the additional medical examination of working citizens (Form RD-1)”)
order of the MHIF dated 18.01.2011 No. 10 (as amended on 07.04.2011) “On the implementation of Decree of the Government of the Russian Federation dated December 31, 2010 No. 1234” (together with the “Procedure for submitting applications for subsidies for medical examinations by territorial compulsory medical insurance funds orphans and children in difficult life situations staying in stationary institutions, and information to complete the calculations for the financial support of the medical examination of orphans and children in difficult life situations staying in stationary institutions”, “Procedure for maintaining and submitting registers of accounts to pay for the costs of medical examinations of orphans and children in difficult life situations staying in stationary institutions")
Order of the Compulsory Medical Insurance Fund dated January 19, 2011 No. 12 “On approval of the procedure for the territorial compulsory medical insurance funds to conduct a medical and economic examination of invoices submitted by medical organizations for payment of expenses related to medical examination of orphans and children in difficult life situations staying in inpatient institutions”
Order of the Compulsory Medical Insurance Fund dated January 19, 2011 No. 13 “On approval of the procedure for the territorial compulsory medical insurance funds to conduct a medical and economic examination of invoices submitted by medical organizations for payment of expenses related to additional medical examination of working citizens”
order of the MHIF dated August 16, 2011 No. 146 “On approval of reporting forms”
Order of the Compulsory Medical Insurance Fund of August 16, 2011 No. 144 “On Amendments to the Procedure for Organizing and Controlling the Volumes, Terms, Quality and Conditions for the Provision of Medical Assistance under Compulsory Medical Insurance, approved by Order of the Federal Compulsory Medical Insurance Fund of December 1, 2010 No. 230”
order of the MHIF dated 12.12.2011 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 Medical Insurance Fund to the budgets of territorial compulsory medical insurance funds”
order of the MHIF dated 13.12.2011 No. 230 “On approval of the procedure for maintaining the territorial register of experts in the quality of medical care by the territorial fund of compulsory medical insurance and posting it on the official website of the territorial fund of compulsory medical insurance on the Internet”
order of the MHIF 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 Medical Insurance Fund for the purposes provided for by Part 12 of Article 51 of the Federal Law “On Compulsory Medical Insurance in the Russian Federation”
Order of the Compulsory Medical Insurance Fund of December 26, 2011 No. 245 “On Amendments to the Procedure for Using the Normalized Insurance Reserve Funds of the Territorial Compulsory Medical Insurance Fund, approved by Order of the Federal Compulsory Medical Insurance Fund of December 1, 2010 No. 227”

2010

order of the MHIF dated 01.01.2010 No. 230 “On approval of the procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance”
order of the MHIF 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 implementation regional programs Modernization of health care of subjects of the Russian Federation in the period 2011-2012"

2008

order of the MHIF 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 submitting a report on the use of subsidies for conducting an additional medical examination of working citizens”, “Procedure for submitting a report by a medical organization on the use of funds for additional medical examinations of working citizens”)
order of the MHIF dated 03.06.2008 No. 120 “On approval of the form and procedure for submitting reports on the use of subsidies for medical examinations of orphans and children left without parental care in stationary institutions”

CHI news

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Clarifications on the procedure for submitting a Notification on the implementation of activities in the field of CHI in the Vladimir Region in 2019

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

Gratitude to the TFOMS of the Vladimir Region

01/24/2017: About the updated sample application for the choice (replacement) of an insurance medical organization

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

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

On August 01, 2016, the medical insurance organization CJSC Capital Medical Insurance ceased its activities in the field of compulsory medical insurance

05/26/2016: On the launch of the contact center in the field of compulsory medical insurance in the Vladimir region

From June 01, 2016, a contact center in the field of compulsory medical insurance begins its work in the Vladimir region

Territorial Compulsory Medical Insurance Fund of the Vladimir Region

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

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

↯ More articles in the journal

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 of influence as a fine.

Possibility of retention wages sums for improper performance of labor duties are 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 order FFOMS N 230

Fifth group

The fifth group - violations due to the fault of the medical organization of continuity in treatment, unreasonable or non-core hospitalization of the insured person. The basis for such a conclusion of experts will be a violation of the procedures for the provision of medical care or hospitalization criteria.

Important! Non-compliance with the criteria for hospitalization includes the absence of medical indications for staying in a round-the-clock 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 an iatrogenic disease. Iatrogenicity is the deterioration of health or the emergence of a new disease due to any medical effects.

Seventh group

The seventh group - non-submission without objective reasons of primary medical documentation confirming the fact of rendering 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

Eighth group - design defects that prevent the examination of the quality of medical care and make it impossible to assess the dynamics of the state of health of the insured person, the volume, nature and conditions for the provision of medical care.

Important! Defects in the design of primary medical documentation are detected in violation of the approved rules for its execution

Identification of defects in medical care (medical care standards are violated) gives 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 the 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 the Federal Law of November 21, 2011 No. 323-FZ, a medical worker has an employment relationship with a medical organization. He is the subject of labor law, and the implementation of medical activities is his labor duty.

Important! For improper performance of labor 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 h. 1 Article. 192 of the Labor Code of the Russian Federation for non-performance or improper performance due to the fault of the employee of the labor duties assigned to him, the employer has the right to apply:

Comment.
Rebuke.
Dismissal on relevant grounds. 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 at present, there are no special disciplinary sanctions for medical workers.

Based on Part 4 of Art. 192 of the Labor Code of the Russian Federation, it is not allowed to apply disciplinary sanctions that are not provided for by Federal laws, charters and.

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

Otherwise, the actions of the employer 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 impossibility of holding 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, the material liability of a party to an employment contract occurs for damage caused to the other party to the contract as a result of guilty unlawful behavior (action 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 the 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 is understood as a real decrease in the employer's cash property or deterioration of the said property, as well as the need for the employer to make costs 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, the employee is liable for the damage caused only within the limits of his average monthly earnings.

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

causing damage in a state of alcoholic, narcotic or other toxic intoxication;
intentional damage;
causing damage as a result of criminal acts established by a court verdict;
causing damage as a result of an administrative offense.

In accordance with paragraph 15 of the Decree of the Plenum of the Supreme Court of the Russian Federation dated November 16, 2006 No. 52 “On the application by the courts of legislation governing the 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 causal relationship between his guilty 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 on compensation for damage by the employee, the obligation to prove which rests with the employer, include:

the absence of circumstances excluding the liability of the employee;
unlawfulness of the behavior (action or inaction) of the tortfeasor; fault of the employee in causing damage;
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 liability.

It should be noted 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 obligation of the employee to compensate the employer the amount of the fine paid by him for violation of the current legislation by third parties.

This point of view is expressed in the decision of the Presidium of the Khanty-Mansiysk Autonomous Okrug - Yugra Court of August 28, 2015 No. 44G-37 / 2015, in the Appellate Ruling of the Moscow City Court of July 24, 2013 No. 11-23629 / 2013.

What needs to be proven

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

Existence of direct actual damage.
The wrongfulness of the behavior (action or inaction) of a medical worker - the tortfeasor.
The fault of the medical worker in causing damage.
The presence of a causal relationship between the behavior of the employee and the damage that has occurred.

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

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

It is worth noting that if the actions of medical workers contain elements of a crime (for example, under Article 118 of the Criminal Code of the Russian Federation - causing grievous bodily harm through negligence), then after a guilty verdict is passed, the employee can be held by the employer to full liability.

Another issue 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 the current legislation, the employer is not entitled to deduct from the employee's salary the amount paid for a poor-quality service.

In accordance with Part 1 of Art. 137 of the Labor Code of the Russian Federation, deductions from the 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 related to the improper performance of labor duties by an employee.

Thus, the Labor Code of the Russian Federation and other regulatory legal acts it is not possible to recover from the 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 of them). This is possible if the employee fails to meet the indicators and conditions for calculating incentive payments.

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

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

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

In red. Order of the FFOMS dated August 16, 2011 No. 144

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

1. Approve the attached Procedure for organizing and monitoring the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance (hereinafter referred to as the Procedure).

2. Heads of territorial funds of compulsory medical insurance and insurance medical organizations use the attached Procedure when organizing and monitoring the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance.

The procedure for organizing and monitoring the volumes, terms, quality and conditions for the provision of medical care under compulsory medical insurance

I. General provisions

1. This Procedure for organizing and monitoring the volumes, terms, quality and conditions for the provision of medical care under compulsory medical 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 "(Collected Legislation of the Russian Federation, 06.12.2010, No. 49, Art. 6422) and determines the rules and procedure for organizing and conducting compulsory medical insurance organizations and funds for monitoring the volume, timing, quality and conditions for the provision of medical care by medical organizations in the amount and on the terms established by the territorial program of compulsory medical insurance and the contract for the provision and payment of medical care under compulsory medical 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 program of compulsory medical insurance and the contract for the provision and payment of medical care for compulsory medical insurance involved in the implementation of compulsory health insurance programs.

II. Objectives of controlling the volumes, terms, quality and conditions of providing medical care under compulsory medical insurance

3. The control of the volumes, terms, quality and conditions for 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 expertise and expertise of the quality of medical care.

4. The object of control is the organization and provision of medical care under compulsory medical insurance. The subjects of control are territorial compulsory health insurance funds, insurance medical 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 medical insurance.

5. Goals of control:

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

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

5.3. prevention of defects in medical care resulting from non-compliance of the medical care provided with the state of health of the insured person; non-compliance and / or incorrect implementation of the 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. verification of the fulfillment by insurance medical organizations and medical organizations of obligations to pay and provide free medical care to insured persons under compulsory medical insurance programs;

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

5.6. optimization of expenses for paying for medical care in the event of insured event and reduction of insurance risks in compulsory health insurance.

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

III. Medico-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 invoices provided for payment by the medical organization to the terms of contracts for the provision and payment of medical care under the compulsory medical insurance of the territorial program of compulsory medical insurance, methods of payment for medical care and tariffs for payment for medical care.

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

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

1) verification of registers of accounts for compliance with the established procedure for information exchange in the field of compulsory medical insurance;

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

3) checking the compliance of the provided medical care:

a) the territorial program of compulsory medical insurance;

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

c) a valid 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 paying for medical care, approved by the authorized federal agency executive power, methods of payment for medical care and tariffs for payment for medical care and an agreement for the provision and payment of medical care under compulsory medical 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 program of compulsory medical insurance, payable at the expense of compulsory medical insurance.

10. The 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 account reduction for each register entry 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 Medical Insurance Fund, are the basis for applying 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 the list of grounds for refusing to pay for medical care (reducing the 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 an examination of the quality of medical care; conducting repeated medical and economic control, repeated medical and economic examinations and examinations of the quality of medical care by the territorial fund of compulsory medical insurance or an insurance medical organization on the instructions of the territorial fund (except for control when making payments for medical care provided to insured persons outside the subject of the Russian Federation, on territory of which the compulsory health insurance policy was issued).

IV. Medical and economic expertise

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

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

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

a) targeted medical and economic expertise;

b) planned medical and economic expertise.

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

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

b) diseases with an extended or shortened period of treatment by more than 50 percent of the established standard of medical care or the average prevailing 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 about the availability of medical care in a medical organization.

15. On the basis of the medical and economic control carried out, the planned medical and economic examination is carried out on invoices submitted for payment within a month after the provision of medical assistance to the insured person under compulsory medical 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 evaluated:

a) the nature, frequency and causes of violations of the rights of insured persons to receive medical care under compulsory health insurance in the amount, 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 program of compulsory medical insurance, payable at the expense of compulsory medical insurance;

c) the frequency and nature of violations by the medical organization of the procedure for the formation of registers of accounts.

17. The volume of monthly scheduled medical and economic examinations from the number of invoices accepted for payment for cases of medical care under compulsory medical insurance is determined by the plan of inspections by insurance medical organizations of medical organizations, agreed by the territorial fund of compulsory medical insurance in accordance with paragraph 51 of section VII of this Procedure, and is not less than:

8% - inpatient care;

8% - medical care provided in a day hospital;

0.8% - outpatient care.

If during the 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 checks from the number of invoices accepted for payment by 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), a planned thematic medical and economic expertise.

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

(As amended by the FFOMS Order No. 144 dated August 16, 2011)

In accordance with Part 9 of Article 40 of the Federal Law, the results of the medical and economic examination, drawn up by the relevant act in the form established by the Federal Compulsory Medical Insurance Fund, are the basis for applying to the 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 assistance under compulsory health insurance and a list of grounds for refusing to pay for medical care (reducing the payment for medical care) (Appendix 8 to this Procedure), and may also be the basis for 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, the examination of the quality of medical care is the identification of violations in the provision of medical care, including the assessment of the correctness of the choice of medical technology, the degree of achievement of the planned result and the establishment of causal relationships of identified defects in the provision of medical care.

21. 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 medical insurance, procedures for the provision of medical care and standards of medical care, established clinical practice.

22. Examination of the quality of medical care is carried out by an expert in the quality of medical care included in the territorial register of experts in the quality of medical care (paragraph 81 of section XIII of this Procedure) on behalf of the territorial compulsory medical insurance fund or an insurance medical 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) scheduled 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, except for the cases determined by the current legislation and the cases set forth in subparagraph e) of paragraph 25 of this section.

(As amended by the FFOMS Order No. 144 dated August 16, 2011)

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 about the availability and quality of medical care in a medical organization;

b) excluded. - Order of the FFOMS dated August 16, 2011 No. 144;

c) deaths in the provision of medical care;

d) nosocomial infection and complications of the disease;

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

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

g) diseases with an extended or shortened period of treatment by more than 50 percent of the established standard of medical care or the average prevailing 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 terms for conducting a targeted examination of the quality of medical care may increase up 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 terms are calculated from the moment the invoice containing information on repeated treatment (hospitalization) is submitted for payment.

The terms for conducting a targeted examination of the quality of medical care from the moment the invoice for payment is provided are not limited in cases of complaints from insured persons or their representatives, deaths, nosocomial infections and complications of diseases, primary disability of people 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 elapsed since the provision of medical care and is carried out in accordance with Federal Law No. 59-FZ of May 2, 2006 "On the procedure for considering citizens' appeals of the Russian Federation" and other regulatory legal acts regulating the 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 conduct on the grounds specified in this Procedure.

29. A planned examination of the quality of medical care is carried out in order to assess the compliance of the volumes, terms, quality and conditions for the provision of medical care to groups of insured persons, divided by age, disease or group of diseases, stage of medical care and other features, conditions stipulated by the contract for the 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 by insurance medical organizations of medical organizations, agreed by the territorial fund of compulsory medical insurance in accordance with paragraph 51 of section VII of this Procedure, and is not less than:

(As amended by the FFOMS Order No. 144 dated August 16, 2011)

in a 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 medical insurance, selected:

a) by random sampling;

b) according to a thematically homogeneous set of cases.

32. A planned examination of the quality of medical care by random sampling is carried out to assess the nature, frequency and causes of violations of the rights of insured persons to timely receive medical care of the volume and quality established by the territorial program of compulsory medical insurance, including those caused by improper implementation of medical technologies that led to a deterioration in health of the insured person, additional risk of adverse consequences for his health, non-optimal 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 providing medical care under compulsory medical insurance, selected by thematic criteria in each medical organization or group of medical organizations providing medical care under compulsory medical insurance of the same type or under 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, the frequency of postoperative complications, the primary disability of people of working age and children, the frequency of repeated hospitalizations, the average duration of treatment, the 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) identifying, establishing the nature and causes of typical (repeating, systematic) errors in the treatment and diagnostic process;

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

35. A scheduled examination of the quality of medical care is carried out in each medical organization providing medical care under compulsory medical insurance at least once during a calendar year within the time limits specified by the inspection plan (paragraph 51 of section VII of this Procedure).

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

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

When consulting, the insured person who applied is informed about the state of his 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.

(As amended by the FFOMS Order No. 144 dated August 16, 2011)

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 Medical Insurance Fund (Appendices 5, 6 to this Procedure), are the basis for applying to the 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 under compulsory health insurance and the list of grounds for refusing to pay for medical care (reducing the payment for medical care) (Appendix 8 to this Procedure).

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

VI. The procedure for the implementation by the territorial fund of compulsory medical insurance of control over the activities of insurance medical organizations

38. The territorial compulsory health insurance fund, on the basis of Part 11 of Article 40 of the Federal Law, exercises control over the activities of insurance medical organizations by organizing control over the volume, timing, quality and conditions for the provision of medical care, conducts medical and economic control, medical and economic examination, examination of the quality of medical assistance, including

39. Repeated medical and economic examination or examination of the quality of medical care (hereinafter referred to as re-examination) - a medical and economic examination conducted 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 adopted conclusions made a specialist expert or an expert on the quality of medical care, who initially conducted a medical and economic examination or an examination of the quality of medical care.

Re-examination of the quality of medical care can be carried out in parallel or sequentially with the first one by the same method, but by another expert of the quality of medical care.

40. The tasks of the re-examination are:

a) verification of the validity and reliability of the conclusion of 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;

b) control over the activities of individual specialists-experts/experts of the quality of medical care.

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

a) carrying out by the territorial fund of compulsory medical insurance of a documentary check of the organization of compulsory medical insurance by a medical insurance organization;

b) detection of violations in the organization of control by the insurance medical organization;

c) groundlessness and/or unreliability of the opinion of the medical care quality expert who conducted the medical care quality assessment;

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

42. The Territorial Compulsory Medical Insurance Fund notifies the insurance medical organization and the medical organization of the re-examination no later than 5 working days before the start of work.

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

insurance medical organization - copies of acts of medical and economic control, medical and economic examination and examination of the quality of medical care necessary for the 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 management body.

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, but not less than 10% of the number of all examinations for the corresponding period of time, including at least 30% of re-examinations of the quality of medical care.

(clause 43 as amended by the Order of the FFOMS dated August 16, 2011 No. 144)

44. The Territorial Compulsory Medical Insurance Fund sends the results of the re-examination, drawn up by the act (Appendix 7 to this Procedure), to the medical insurance organization and the medical organization no later than 20 working days after the end of the inspection. The insurance medical organization and the medical organization are obliged to consider these acts within 20 working days from the date of their receipt.

45. In the absence of agreement with the results of the re-examination, the medical insurance organization and the medical organization 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 Medical Insurance Fund, within 30 working days from the date of receipt, considers the act with the 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 health insurance fund, in the event of violations of contractual obligations on the part of the insurance medical organization, when reimbursed to it for the cost of medical care, reduces payments by the amount of detected violations or unfulfilled contractual obligations.

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

In accordance with the specified agreement, in the event of violations in the activities of the insurance medical organization, the territorial compulsory health insurance fund uses the measures applied to the insurance medical organization in accordance with Part 13 of Article 38 of the Federal Law and the agreement on the financial support of compulsory medical insurance or recognizes those applied by the insurance medical organization to the medical organization measures unreasonable.

47. When detecting violations in the organization and conducting a medical and economic examination and / or examination of the quality of medical care, the territorial fund for compulsory medical insurance sends a claim to the medical insurance organization, which contains information about the control over the activities of the medical insurance organization:

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

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

c) composition of the commission of the territorial fund of obligatory medical insurance;

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

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

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

g) applications (copies of acts of re-examination, etc.).

The claim is signed by the director of the territorial fund of obligatory medical insurance.

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

48. If the territorial fund of compulsory medical insurance reveals during the re-examination of violations missed by the insurance medical organization during the medical and economic examination or examination of the quality of medical care, the insurance medical organization loses the right to use the measures applied to the medical organization, due to a defect in the medical assistance and/or disruption in the provision of medical care.

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

(clause 49 as amended by the Order of the FFOMS dated August 16, 2011 No. 144)

50. The Territorial Compulsory Medical Insurance Fund analyzes the applications of the insured persons, their representatives and other subjects of compulsory medical insurance based on the results of the control carried out by the insurance medical 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 that ensures the functioning of control and protection of the rights of insured persons, coordinates the plans for the activities of insurance medical organizations in terms of organizing and conducting control, including plans inspections by insurance medical 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 and economic examination and examination of the quality of medical care, a medical organization provides specialist experts and experts in the quality of medical care within 5 working days after receiving a relevant request, medical, accounting, reporting and other documentation, 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 is not entitled to prevent specialist experts and experts in the quality of medical care from accessing the materials necessary for conducting a medical and economic examination, an examination of the quality of medical care, and is obliged to provide the requested information.

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

55. On the basis of Article 42 of the Federal Law, the resolution of disputes and conflicts arising in the course of control between a medical organization and a medical insurance organization is carried out by the territorial compulsory medical insurance fund.

The commission informs the interested parties and the executive authority of the subject 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 insurance medical organizations to the territorial fund of compulsory medical insurance.

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

Recording 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 the control in the form of acts are transferred to the medical organization within 5 working days.

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

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

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

58. The head of the medical organization or the person replacing him considers the act 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 medical 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. Based on the analysis of the activities of subjects of control, the Territorial Compulsory Medical Insurance Fund develops proposals that contribute to improving the quality of medical care and the efficiency of using compulsory medical insurance resources and informs the executive authority of the constituent entity of the Russian Federation in the field of healthcare and territorial body Federal Service on supervision in the field of health and social development.

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

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

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 medical insurance funds about identified violations in the provision of medical care under the territorial program of compulsory medical insurance, including the results of control.

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

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

64. In insurance medical organizations that organize the service of representatives of insurance medical organizations for the implementation in medical organizations participating in the implementation of compulsory medical insurance programs, work to protect the rights and legitimate interests of insured persons, representatives of insurance medical organizations take part in the preparation and placement of information materials on protection of the rights of insured persons and the results of control, as well as 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 the 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 medical insurance, the list of grounds for refusing to pay for medical care or reducing 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 refusing to pay for medical care (reducing the payment for medical care) are:

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

exclusion of a position from the register of accounts subject to payment of volumes of medical care;

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

return of amounts not payable to the insurance medical organization;

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

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 in relation to the volume, timing, quality and conditions of providing medical care are detected, the insurance medical organization does not partially or fully reimburse the expenses of the medical organization for the provision of medical care, reducing subsequent payments on the accounts of the medical organization 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 that is not payable based on the results of the control is withheld from the amount of funds provided for paying for medical care provided by a medical organization, or is subject to return to the medical insurance organization in accordance with the contract 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 refusing (reducing) payment for medical care (Appendix 8 to this Procedure) on the basis of an order containing:

a) the heading (number and date of the prescription, place of issuance, 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 medical care defect/violation in the provision of medical care in accordance with Appendix 8 to this Procedure, the amount and deadline for paying the fine);

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

(Clause 69 as amended by the Order of the FFOMS dated August 16, 2011 No. 144)

70. If there are two or more grounds for refusing to pay for medical care or reducing payment for medical care in the same case of medical care, one - the most significant reason 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 the 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 applying sanctions to a medical organization for violations identified during the control are spent in accordance with the Federal Law.

XI. Appeal by a medical organization of 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 against 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 an insurance medical organization by sending a claim to the territorial compulsory medical insurance fund according to the recommended sample (Appendix 9 to this order).

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

a) substantiation of 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, considers 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 the decision of the territorial fund.

75. The decision of the territorial compulsory health insurance fund, recognizing the correctness of the medical organization, is the basis for the cancellation (change) of the decision on non-payment, incomplete payment of medical care and / or on the payment of a fine by the medical organization 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 Medical 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 Medical Insurance Fund.

(the paragraph was introduced by the Order of the FFOMS dated August 16, 2011 No. 144)

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

76. If the 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 fund of compulsory medical insurance of control when making payments for medical care provided to insured persons outside the subject of the Russian Federation in whose territory the compulsory medical insurance policy was issued

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

XIII. Employees who carry 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 with at least five years of experience in the medical specialty and who has undergone appropriate training in expert activities in the field of compulsory medical insurance.

79. The main tasks of a specialist expert are:

a) monitoring the compliance of the provided medical care with the terms of the contract for the provision and payment of medical care under compulsory health insurance by establishing the correspondence between the actual terms of the provision of medical care, the volume of medical services provided for payment to 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 the actual data on the 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 substantiation of the need for it, preparation of documentation necessary for an expert on the quality of medical care to conduct an examination of the quality of medical care;

c) preparation of materials used by the methodological base for the examination of the quality of medical care (procedures for the provision of medical care and standards of medical care, clinical protocols, guidelines and other);

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

f) familiarization of the management of the medical organization with the results of the 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 the insured persons with the organization, conditions and quality of the medical care provided.

81. Examination of the quality of medical care in accordance with Part 7 of Article 40 of the Federal Law is carried out by an expert on the quality of medical care, who is a medical specialist with a higher professional education, certificate of accreditation of a specialist or certificate of a specialist, work experience in the relevant medical specialty for 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 (paragraph 84 of this section).

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

When conducting an examination of the quality of medical care, the expert on the quality of medical care has the right to remain anonymous/confidential.

82. The main task of an expert in the quality of medical care 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.

An expert on the quality of medical care 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 the treatment of which the 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 treatment and diagnostic process, if necessary, performs an examination of patients;

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

c) observes the rules of medical ethics and deontology, maintains medical secrecy 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 (paragraph 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.

(clause "d" as amended by the Order of the FFOMS dated 16.08.2011 No. 144)

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

The maintenance of the territorial register of medical care quality experts is carried out by the territorial compulsory health insurance funds in accordance with paragraph 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 experts in the quality of medical care shall be borne by the director of the territorial fund of compulsory medical insurance.

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.

Attachment 1

Act * medical and economic control

Heading part:
Number of the Act, date of its compilation.
Name of the insurance medical organization. Name of the medical organization.
The number of the register of accounts, the period for which it is provided.

Content
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 a 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.
Explanation of the 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 (may be presented in tabular form).
The amount excluded from payment, based on the results of the medical and economic control.
The amount of financial sanctions for defects in medical care / violations in the provision of medical care in the event that an act is filled out according to this form based on the results of repeated medical and economic control conducted by the territorial fund of compulsory medical insurance.
The total amount accepted for payment.

Assurance part
Position, signature of the employee who carried out the medical and economic control.
Position, signature of the responsible person of the insurance medical organization (territorial fund of compulsory medical insurance), approving the Act.
Position, signature of the head of the medical organization, familiarized with the Act.

__________________________________

* According to this form, the act is also filled out during the 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 HMO (TF) that received invoices from the medical organization

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

for honey. assistance in a day hospital in the amount of: _________ rub. _______ accounts
for outpatient medical assistance in the amount of: _____ rubles. ____ accounts
2. Not approved for payment of registers of accounts in the amount of: __________ rub.
Including: for inpatient medical care in the amount of: _____ rubles. ____ accounts
for medical care in a day hospital in the amount of: _____ rubles. ____ accounts
for outpatient medical care in the amount of: __________ rub.
______ accounts
for exceeding the agreed volume of medical services in the amount of: ______ rubles.
2.1. Not payable _______ invoices in the amount of _________ rubles.
2.1.1. for inpatient medical care in the amount of: ______ rubles. ____ 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. expelled

2.3. Not accepted for payment due to the excess of the agreed volume of medical services for a total amount of _________________ rub.:

Departments of the Moscow Region	Department code	Period in which the agreed volumes were exceeded (quarter)	The value of exceeding the agreed volumes of medical services (per day, visits, SUET)	Amount not payable due to exceeding the agreed volumes	Amount not accepted for payment due to exceeding the agreed volumes	Including: before the re-IEC	Amount held in the current month	Amount to be withheld in the subsequent period
1	2	3	4	5	6	7	8	9

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

Annex 3

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

1. Date of the examination ________________________________________________

2. Surname, name, patronymic of the specialist-expert _________________________________

___________________________________________________________________________

3. Name of the auditing organization ____________________________________

___________________________________________________________________________

4. Name of the medical organization _____________________________________

___________________________________________________________________________

5. Medical bill number _______________________________________________

6. No. of compulsory medical insurance policy ___________________________

___________________________________________________________________________

7. Medical card number (outpatient or inpatient)

___________________________________________________________________________

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

___________________________________________________________________________

9. Diagnosis of concomitant disease _______________________________________

___________________________________________________________________________

10. Terms of treatment from _________________________ to _____________________________

11. Cost of treatment _____________________________________________________________

12. Duration of the disease _________________________________________________

13. Surname, 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 and reporting 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 records _____ (medical records

outpatient / inpatient, other accounting and reporting documentation)

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

3. Identified defects in medical care / violations in the provision of medical

assistance: ______________________________________

Further, all identified defects in medical care / violations are indicated.

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.

In total, the amount of _____ rubles is not payable. A fine in the amount of ______ rubles. Total

payable: _____ rub.

Total payable: ______________ rub.

Specialist-expert economist of an insurance medical organization _______________
___________________

"__" __________ 201_

Head of medical organization ________________

M.P.

Annex 5

The act of examination of the quality of medical care (target)
No. ___ dated __________

"__" __________ 201_

Medical care quality expert

___________________________________________

(Full name of the expert)

on behalf of

___________________________________________________________________________

(name of sending organization)

Instruction 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 card (outpatient, inpatient) of the patient, other

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, this case was analyzed with the management
medical organization.

Signature of the medical care quality expert ______________________________

Signature of a representative of an insurance medical organization (territorial

fund of obligatory medical insurance) _____________________________

Signature of the representative of the medical organization _____________________________

M.P.

Compiled in duplicate

Appendix 6

Act
examination of the quality of medical care (scheduled)
No. ______ dated __________________

in _________________________________________________________________________

(name of medical organization, address)

in accordance with the contract dated ____________ No. ________

Organization that carried out the audit: ______________________________________________

FULL NAME. medical quality expert

assistance (or identification number): _____________________________________

Checked period: from ___________ to __________

Date of examination of the quality of medical care: ___________________

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

Annex 7

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

On the basis of the order of the director of the territorial fund of mandatory
health insurance ________________ (name)

dated "__" ________________ 201_ No. ____________

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

underline as appropriate): ____________ (position) _____________ (full name

____________ (position) __________________ (full name)

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

conducted by the CMO _________________________________________________________________

CMO name

CMO location address _________________________________________________

Date of inspection __________________________________________________

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

in a medical organization

___________________________________________________________________________

name of the medical organization, city, district

Accepted for payment ___________ bills for treated insured

of which: inpatient care - ______________________,

medical care in a day hospital - _________________,

outpatient care - ______________________.

QMS conducted by MEE/ECMP (underline as appropriate) _______________ 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. Re-examination of _____________ cases (___%) was carried out.

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

SMO in ___________ cases (___%), namely:

2.1. In _________________ cases (___%), the specialists of the Territorial Compulsory Medical Insurance Fund revealed violations committed by a medical organization, but not identified by the HMO.

- No. of payment order, No. of compulsory health insurance policy, period of treatment, number of bed-days (visits, services, UET), rate of the completed case, diagnosis (main, concomitant), 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 a medical organization, but not identified by the HMO;

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

Account amount ___________ rub., amount of financial sanctions _______ rub.

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

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

3.1. In ___________ cases (___%), the specialists of the Territorial Compulsory Medical Insurance Fund identified violations committed by the specialists of the HMO during the MEE / ECMP (underline as necessary).

The description of the specific case of the identified violation includes:

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

The essence of the identified SMO violation;

Expert opinion adopted by the CMO indicating the amount of underpayment;

Violation committed by the CMO during the organization and conduct of the IEE / ECMP.

Account amount ____________ rub.

The amount of _____ rubles unreasonably withheld by the HMO from a medical organization.

The amount of financial sanctions ___________ rub.

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

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

Financial sanctions in the amount of _________ rub.

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

______________________________________

Notes: * Re-examination.

Annex 8

List of grounds for refusing to pay for medical care (reducing payment for medical care)

Section 1 Violations Restricting Access to 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 program of compulsory medical insurance;
1.1.2.	to choose a doctor by submitting an application in person 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 the waiting time for medical care provided in a planned manner.
1.2.	Unreasonable refusal to insured persons in the provision of medical care in accordance with the territorial CHI program, including:
1.2.1.
1.2.2.	causing harm to health, or creating a risk of progression of an existing disease, or creating a risk of a new disease;
1.3.	Unjustified denial to insured persons of free medical care in the event of an insured event outside the territory of the subject of the Russian Federation in which the compulsory medical insurance policy was issued, in the amount established by the basic program of compulsory medical insurance, including:
1.3.1.	that did not cause harm to health, did not create a risk of progression of an existing disease, did not create a risk of a new disease:
1.3.2.	resulting in harm to health, or created a risk of progression of an existing disease, or created a risk of a new disease.
1.4.	Collection of payment from insured persons (within the framework of voluntary medical insurance or in the form of paid services) for the medical care provided, provided for by the territorial program of compulsory medical insurance.
1.5.	Acquisition by the patient of medicines and medical products during the period of stay in the hospital as prescribed by the doctor, included in the "List of Vital and Essential Medicines", "Inpatient Patient Cookies Form", agreed and approved in the prescribed manner; based on standards of medical care.
Section 2. Lack of awareness of the insured population
2.1.	The absence of an official website of a medical organization on the Internet.
2.2.	The 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 periods for medical care:
2.2.3.	on 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.	The absence of the following information on information stands in medical organizations:
2.4.1.	about the mode of operation 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 periods 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 drugs used in the provision of inpatient medical care, as well as emergency 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, in the outpatient treatment of which medicines and medical devices are dispensed by prescription of doctors free of charge, as well as in accordance with the list of population groups, in the outpatient treatment of which medicines are dispensed according to doctor's prescriptions with a 50% 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 the prescribed manner (established at the request of insured persons).
3.2.	Failure to perform, untimely or improper performance of diagnostic and (or) therapeutic measures necessary for the patient, surgical interventions in accordance with the procedure for providing medical care and (or) standards of medical care:
3.2.1.	not affecting the state of health of the insured person;
3.2.2.	leading to an extension of the treatment period beyond the established ones (with the exception of cases when the insured person refuses medical intervention and (or) lacks a written consent to treatment, in cases established by the legislation of the Russian Federation);
3.2.3.	that led to the deterioration of the health of the insured person, or created a risk of progression of an existing disease, or created a risk of a new disease (except in cases where the insured person refuses treatment, issued in accordance with the established procedure);
3.2.4.	leading to disability (with the exception of cases when the insured person refuses treatment, issued in accordance with the established procedure);
3.2.5.	resulting in a fatal outcome (with the exception of cases when the insured person refuses the treatment issued in accordance with the established procedure).
3.3.	Implementation of unindicated, unjustified from a clinical point of view, activities not regulated by the standards of medical care:
3.3.1.	leading to a lengthening of the terms of treatment, an increase in the cost of treatment in the absence of negative consequences for the health of the insured person;
3.3.2.	which led to the deterioration of the health status of the insured person, or created a risk of progression of an existing disease, or created a risk of a new disease (except in cases where the insured person refuses treatment, issued in accordance with the established procedure).
3.4.	Premature from a clinical point of view, the termination of therapeutic measures in the absence of a clinical effect (except for cases of refusal of treatment in the prescribed manner).
3.5.	Repeated reasonable appeal of the insured person for medical care for the same disease within 30 days from the date of completion of outpatient treatment and 90 days from the date of completion of treatment in a hospital, due to the lack of positive dynamics in the state of health, confirmed by a targeted or planned examination (except for cases staged treatment).
3.6.	Violation due to the fault of a medical organization of continuity in treatment (including untimely transfer of a patient to a medical organization of a higher level), which led to an extension of the terms of treatment and (or) deterioration in the health of the insured person.
3.7.	Hospitalization of the insured person without medical indications (unreasonable hospitalization), whose medical care could be provided in the prescribed amount in an outpatient setting, in a day hospital.
3.8.	Hospitalization of the insured person, whose medical care should be provided in a hospital of a different profile (non-core hospitalization), except for cases of hospitalization for urgent indications.
3.9.	Unreasonable lengthening of the terms of treatment due to the fault of the medical organization, as well as an increase in the number of medical services, visits, bed-days, not related to the implementation of diagnostic, therapeutic measures, surgical interventions within the framework of the standards of medical care.
3.10.	Repeated visits to a doctor of the same specialty on the same day when providing outpatient medical care, with the exception of a repeated visit to determine indications for hospitalization, surgery, consultations in other medical organizations.
3.11.	Action or inaction of the medical personnel, which caused the development of a new disease of the insured person (development of an iatrogenic disease).
3.12.	Unreasonable prescription of drug therapy; simultaneous administration of drugs-synonyms, 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.	Non-fulfillment, through the fault of a medical organization, of a mandatory post-mortem autopsy in accordance with applicable law.
3.14.	The presence of discrepancies in the clinical and pathoanatomical diagnoses of 2-3 categories.
Section 4. Defects in the execution of primary medical documentation in a medical organization
4.1.	Failure to submit primary medical documentation confirming the provision of medical care to the insured person in a medical organization without objective reasons.
4.2.	Defects in the execution of primary medical documentation that impede the examination of the quality of medical care (the inability to assess the dynamics of the state of health of the insured person, the volume, nature and conditions of the provision of medical care).
4.3.	Absence in the primary documentation: informed voluntary consent of the insured person to medical intervention or refusal of the insured person from medical intervention and (or) written consent to treatment, in cases established by the legislation of the Russian Federation.
4.4.	The 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 taken, the clinical picture of the disease).
4.5.	The date of provision of medical care, registered in the primary medical documentation and the register of accounts, does not correspond to the doctor's time sheet (providing medical care during holidays, studies, business trips, days off, etc.).
4.6.	Inconsistency of primary medical documentation data with the account register data, including:
4.6.1.	inclusion in the bill for payment of medical care and the register of accounts of visits, bed-days, etc., not confirmed by primary medical documentation;
4.6.2.	inconsistency of the terms of treatment, according to the primary medical documentation, of the insured person with the terms indicated in the account register;
Section 5. Violations in the execution and presentation for payment of invoices and registers of invoices
5.1.	Violations related to the execution and presentation for payment of invoices and invoice registers, including:
5.1.1.	the presence of errors and / or inaccurate information in the account details:
5.1.2.	the amount of the invoice does not correspond to the total amount of medical care provided according to the register of accounts;
5.1.3.	the presence of blank fields in the register of accounts that are mandatory;
5.1.4.	incorrect filling of the fields of the register of accounts;
5.1.5.	the declared amount for the position of the register of accounts is not correct (contains an arithmetic error);
5.1.6.	the date of provision of medical care in the register of accounts does not correspond to the reporting period / payment period.
5.2.	Violations related to determining the belonging of the insured person to an insurance medical organization:
5.2.1.	inclusion in the register of accounts of cases of medical care provided to a person insured by another insurance medical organization;
5.2.2.	introduction of inaccurate personal data of the insured person into the register of accounts, leading to the impossibility of its full identification (mistakes in the series and number of the CHI 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 subject of the Russian Federation;
5.2.4.	availability of outdated data on insured persons in the account register;
5.2.5.	inclusion in the registers of accounts of cases of medical care provided to categories of citizens who are not subject to compulsory medical insurance insurance in the territory of the Russian Federation.
5.3.	Violations related to the inclusion in the register of medical care that is not included in the territorial CHI 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 payable from other sources of financing (severe industrial accidents paid by the Social Insurance Fund).
5.4.	Violations related to the unreasonable application of the tariff for medical care:
5.4.1.	Inclusion in the register of invoices of cases of medical care provided at tariffs for payment for medical care that are not included in the tariff agreement;
5.4.2.	Inclusion in the register of invoices of cases of medical care provided at tariffs for paying for medical care that do not correspond to those approved in the tariff agreement.
5.5.	Violations related to the inclusion in the register of accounts of unlicensed types of medical activities:
5.5.1.	Inclusion in the register of accounts of cases of medical care by types of medical activities that are not in the current license of a medical organization;
5.5.2.	Provision of registers of accounts in case of termination of the license of a medical organization in accordance with the established procedure:
5.5.3.	Provision of invoice registers for payment in case of violation of licensing conditions and requirements in the provision of medical care: these licenses do not correspond to the actual addresses of the medical organization's licensed type of activity, etc. (upon the fact of detection, as well as on the basis of information from the 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 register item previously paid (re-invoicing for medical care cases that were previously paid);
5.7.2.	Duplication of medical care cases in one register;
5.7.3.	The cost of a separate service included in the bill is taken into account in the tariff for payment for medical care of another service, also presented for payment by a 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 CHI system.
5.7.5.	Inclusion in the register of medical care accounts: - outpatient visits during the period of stay of the insured person in a round-the-clock 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 the insured person's stay in a day hospital during the period of the patient's stay in a round-the-clock 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 the insured person in one payment period with the intersection or coincidence of treatment terms.

the following reasons: 1. No. of compulsory medical insurance policy ________________________ Settlement amount ________________________________ Justification of disagreement _________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 2. 3. In total, I consider the amount of mutual settlements for ___ insured to be unreasonable
persons (-s) for a total amount of __________________ rubles. Applications: 1) Materials of internal and departmental quality control
medical care on ______ sheet(s, -ax);

Annex 10

No. p / p	CHI policy number	Source of information (e.g. number medical card amb. / stats. sick)	Dates of circulation		ICD code	Paid for medical services	Medical defect code assistance/violations	Size mutual settlement	Service mark
No. p / p	CHI policy number		Start	the end	ICD code	Paid for medical services	Medical defect code assistance/violations	Size mutual settlement	Service mark
1	2	3	4	5	6	7	8	9	10




Total							-		-

Annex 11

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

Name of the auditing organization ______________________________________

Medical record (ambulance / stationary) of patient No. ___, attending physician _____________

No. of compulsory medical insurance policy _____________ Gender _________

Date of Birth _____________________

Address of the insured person ________________________________________________

Name of the medical organization ______________________________________

Account No. _______ dated "__" _______________________ 201_

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

department ______________________________________ from ____ to ____, c / d. ____;

Medical care quality expert ______________________________________

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

Admission: emergency, planned.

Outcome of the case: recovery, improvement, no change, deterioration, death,
unauthorized care, transferred (sent) for hospitalization (where), other

___________________________________________________________________________

Operation _____________________, date "__" ____________________ 201_

Final clinical diagnosis:

___________________________________________________________________________

Pathological anatomical diagnosis:

basic __________________________________________________________________

___________________________________________________________________________

complication ________________________________________________________________

___________________________________________________________________________

concomitant _____________________________________________________________

___________________________________________________________________________

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

and instrumental studies, consultations of specialists, council)

___________________________________________________________________________

Justification of the negative consequences of errors in the collection of information:

___________________________________________________________________________

II. DIAGNOSIS (formulation, content, time of setting)

basic __________________________________________________________________

___________________________________________________________________________

complication ________________________________________________________________

___________________________________________________________________________

concomitant _____________________________________________________________

___________________________________________________________________________

Justification of the negative consequences of errors in the diagnosis:

___________________________________________________________________________

III. TREATMENT (surgical, including obstetrics, medication,

other types and methods of treatment)

___________________________________________________________________________

Justification of the negative consequences of errors in treatment:

___________________________________________________________________________

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

___________________________________________________________________________

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

___________________________________________________________________________

CONCLUSION of the medical care quality expert:

___________________________________________________________________________

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

___________________________________________________________________________

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

M.P.

ON RECOGNIZING NUMBER OF NORMATIVE LEGAL ACTS OF THE MHIF

SCROLL NORMATIVE LEGAL ACTS OF THE FEDERAL FUND FOR MANDATORY HEALTH INSURANCE

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

changes, included in the Procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance, approved by order of the Federal Compulsory Medical Insurance Fund dated December 1, 2010 N 230

Document overview

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Imposition of fines: scope of order FFOMS N 230

Fifth group

Sixth group of defects

Seventh group

Eighth group

Liability for damage caused

What needs to be proven

SCROLL
NORMATIVE LEGAL ACTS OF THE FEDERAL FUND FOR MANDATORY HEALTH INSURANCE

changes,
included in the Procedure for organizing and monitoring the volume, timing, quality and conditions for the provision of medical care under compulsory medical insurance, approved by order of the Federal Compulsory Medical Insurance Fund dated December 1, 2010 N 230