The Regulations on the Supervision and Administration of the Use of Medical Insurance Funds stipulates the personnel who supervise and inspect the use of medical insurance funds.
The use of cross-regional medical security funds shall be inspected by the administrative department of medical security designated by the administrative department of medical security at the next higher level. Twenty-seventh medical security administrative departments to implement supervision and inspection, can take the following measures: (1) to enter the site inspection; (two) ask the relevant personnel; (three) require the inspected object to provide documents and materials related to the inspection items, and make explanations and explanations; (4) Collecting relevant information and materials by means of audio recording, audio recording, video recording, photographing or copying; (5) sealing up materials that may be transferred, concealed or lost; (six) to hire qualified accounting firms and other third-party institutions and professionals to assist in the inspection; (seven) other measures stipulated by laws and regulations. Twenty-eighth medical security administrative departments can entrust organizations that meet the statutory conditions to implement medical security administrative law enforcement. Twenty-ninth supervision and inspection of the use of medical insurance funds, supervision and inspection personnel shall not be less than two, and shall produce law enforcement certificates. When the administrative department of medical security conducts supervision and inspection, the inspected object shall cooperate with it, truthfully provide relevant data and information, and shall not refuse or obstruct the inspection or make a false report or conceal it. Thirtieth designated medical institutions suspected of defrauding medical insurance funds, during the investigation, the administrative department of medical insurance can take measures such as increasing the frequency of supervision and inspection and strengthening cost monitoring. , to prevent the loss from expanding. Designated medical institutions refused to cooperate with the investigation, with the approval of the main person in charge of the administrative department of medical security, the administrative department of medical security may request the medical security agency to suspend the settlement of the medical security fund. After investigation, those who defraud the medical insurance fund fees shall be dealt with in accordance with the provisions of Article 40 of these regulations; If it does not belong to defrauding medical insurance fund expenditure, it shall be settled in accordance with the provisions. If the insured person is suspected of defrauding the medical insurance fund and refuses to cooperate with the investigation, the administrative department of medical security may request the medical insurance 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. After investigation, those who defraud the medical insurance fund fees shall be dealt with in accordance with the provisions of Article 41 of these regulations; If it does not belong to defrauding medical insurance fund expenditure, it shall be settled in accordance with the provisions.