Original title: The medical insurance supervision regulations will implement fraudulent insurance on May 1 and impose a fine of more than 2 times and less than 5 times the amount defrauded
On February 19, the State Council announced the “MedicalfundUse supervisionmanagementRegulations“, will be officially implemented on May 1 this year. The promulgation of the “Regulations” will change the lack of special laws and regulations in my country’s medical security field.
The Regulations have 5 chapters and 50 articles. It stipulates that for the purpose of defrauding insurance, the insured person will suspend the online settlement of medical expenses for 3 to 12 months if the medical insurance certificate is handed over to others for false use, or to repeatedly enjoy the medical insurance benefits, and the amount of fraudulently obtained 2 times or 5 times The following is fine.
The “Regulations” clarify that medical security agencies, designated medical institutions and other units andjobsPersonnel and insured persons shall not defraud medical security funds.
The insured person uses the medical insurance certificate of others to seek medical treatment or purchase medicine under the false name, or through forgery, alteration, concealment, alteration or destruction of medicineInstrument, Medical certificate,accountingcertificate,digital informationAnd other related materials or fictitious medicineserviceProjects and other methods that defraud the expenditure of the medical security fund shall suspend the online settlement of medical expenses for 3 to 12 months, and the medical security administrative department shall impose a fine of 2 times to 5 times the amount of fraud.
If an insured person is suspected of defrauding medical security fund expenditures and refuses to cooperate with the investigation, the medical security administrative department may request the medical security agency to suspend the online settlement of medical expenses. The medical expenses incurred during the suspension of online settlement shall be paid in full by the insured persons.
The “Regulations” clarify that designated medical institutions provide false certification materials by inducing, assisting others to seek medical treatment or purchasing drugs under false names or falsely, or collude with others to falsely chargeDocumentsAnyone who defrauds the expenditure of the medical security fund by other means shall be ordered by the medical security administrative department to return it and impose a fine of more than 2 times and less than 5 times the amount defrauded.
At the same time, the designated medical institution was ordered to suspend relevantresponsibilityThe department involved in the medical services used by the medical security fund for more than 6 months and 1 year, until the service agreement is terminated by the medical security agency;SupervisorDepartments revoke their qualifications in accordance with the law.
In addition, if a designated medical institution is suspected of defrauding medical security fund expenditures, during the investigation period, the medical security administrative department may take measures such as increasing the frequency of supervision and inspection and strengthening cost monitoring to preventStop lossLoss expanded. If the designated medical institution refuses to cooperate with the investigation, the medical security administrative department may request the medical security agency to suspend the settlement of the medical security fund upon the approval of the principal person in charge of the medical security administrative department.
Regarding medical security agencies defrauding medical security fund expenditures, the “Regulations” clearly stipulate that the medical security administrative department shall order the refund and impose a fine of more than 2 times and less than 5 times the amount of fraud. Give sanctions.
During the use of the medical security fund, medical security and other administrative departments, medical security agencies, designated medical institutions and their staff shall not accept bribes or obtain otherIllegal income. If bribes are accepted or other illegal income is obtained, the illegal income shall be confiscated and the responsible persons shall be punished according to law; violations of other laws and administrative regulations shall be dealt with by the relevant competent authorities according to law.
Medical security and other administrative departments, medical security agencies,Accounting firmSuch institutions and their staff shall not use the information or related information of the subject or related information obtained and known during work for purposes other than the supervision and management of the use of the medical security fund, and shall not disclose, tamper with, damage, or illegally provide the personal information of the party to others withbusinesssecret.
(Source: Beijing Youth Daily)
(Editor in charge: DF381)
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