On 20 19, 1 1, the national medical insurance bureau officially announced the "regulations on the use and management of medical insurance funds (draft for comments)" for public consultation, which indicates that the first regulations on the supervision of medical insurance funds will be introduced soon.
For the first time in the exposure draft, the obligations of the insured individuals are clarified, requiring them not to rent (borrow) their valid medical insurance certificates to others; Shall not forge or alter the certification materials to defraud the medical insurance fund. For those forged or altered, the online settlement processing shall be suspended for no more than 12 months, and a fine of 5 times the illegal amount shall be imposed. Anyone suspected of committing a crime will be investigated for criminal responsibility according to law. At the same time, disciplinary measures such as public exposure and inclusion in the list of joint disciplinary targets for dishonesty are given.
The "Regulations" mainly clarify four important aspects of the supervision of the use of medical insurance funds.
1. Supervisory organ
The main users of medical insurance funds mainly include medical insurance agencies, designated medical institutions and insured persons; In addition to the administrative department of medical security, the main body of medical insurance fund supervision also includes various departments related to this work. Article 9 of the Regulations also specifically states that "the State shall establish and improve a unified national medical security handling management system, provide standardized and standardized medical security handling services, and achieve full coverage of provinces, cities, counties, towns (streets) and villages", and puts forward requirements for strengthening the construction of medical security handling institutions specifically responsible for the use and management of funds.