The "Regulations on the Supervision and Management of the Use of Medical Security Funds" was recently released and will be implemented on May 1, 2021.

For the first time, the regulations clarify the obligations of insured persons. If an individual, for the purpose of defrauding insurance, gives the medical insurance certificate to others to use under his/her name, or repeatedly enjoys medical insurance benefits, etc., the online settlement of medical expenses will be suspended for 3 to 12 months, and the amount defrauded will be fined 2

A fine of more than 5 times but less than 5 times shall be imposed.

At the same time, the regulations clearly require that the medical insurance fund shall be earmarked for exclusive use and shall not be embezzled or misappropriated by any organization or individual.

The management regulations contain 50 specific articles, including general principles, fund use, supervision and management, legal responsibilities, and supplementary provisions.

The management regulations require that the medical security fund shall be earmarked for exclusive use and shall not be misappropriated or misappropriated by any organization or individual.

The medical security administrative department of the State Council should establish a credit management system for designated medical institutions, personnel, etc., and incorporate the results of daily supervision and inspections, administrative penalty results, etc. into the national credit information sharing platform and other relevant information disclosure systems.

If a medical insurance agency or designated hospital defrauds insurance, the medical insurance administrative department will order it to return the insurance and impose a fine of not less than 2 times but not more than 5 times the amount defrauded.

Insured persons shall not take advantage of the opportunity to enjoy medical insurance benefits to resell drugs. In terms of fund use, the management regulations point out that insured persons shall not take advantage of the opportunity to enjoy medical insurance benefits to resell drugs, accept returns in cash or in kind, or obtain other illegal benefits.

Designated medical institutions shall not provide convenience for insured persons to take advantage of their opportunity to enjoy medical security benefits to resell drugs, accept returns in cash or in kind, or obtain other illegal benefits.

At the same time, medical security agencies, designated medical institutions and other units and their staff and insured persons are not allowed to forge, alter, conceal, alter or destroy medical documents, medical certificates, accounting vouchers, electronic information and other relevant information.

Or make up medical service items to defraud medical security funds.

The medical security fund is earmarked for exclusive use and may not be misappropriated or misappropriated by any organization or individual.

Establish a credit management system and incorporate punishment results into the credit platform. In terms of supervision and management, the management regulations point out that 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 inspections and strengthening cost monitoring.

Prevent losses from expanding.

If a designated medical institution refuses to cooperate with the investigation, with the approval of the main person in charge of the medical security administrative department, the medical security administrative department may require the medical security agency to suspend the settlement of the medical security fund.

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 require the medical security agency to suspend online settlement of medical expenses.

Medical expenses incurred during the suspension of online settlement will be paid in full by the insured.

After investigation, if it is not fraudulent to obtain expenditures from the medical security fund, settlement will be made in accordance with regulations.

At the same time, the medical security administrative department of the State Council should establish a credit management system for designated medical institutions and personnel, conduct hierarchical and classified supervision and management based on credit evaluation levels, and incorporate the results of daily supervision and inspections, administrative penalty results, etc. into the national credit information sharing platform and other

Relevant information disclosure system, and punishments will be implemented in accordance with relevant national regulations.

Designated hospitals induced and assisted in defrauding medical insurance funds and suspended medical services from June to December. In terms of legal liability, the management regulations pointed out that medical insurance handling agencies forged, altered, concealed, altered, destroyed medical documents, medical certificates, accounting vouchers, electronic

Anyone who defrauds medical security fund expenditures by using information and other relevant materials or fictitious medical service items will be ordered to return it by the medical security administrative department, and a fine of not less than 2 times but not more than 5 times of the amount defrauded will be imposed. The directly responsible person in charge and other directly responsible personnel

Punishment shall be imposed in accordance with the law.

For designated hospitals, anyone who induces or assists others to fake their names or falsely seek medical treatment or purchase medicines, provides false certification materials, or colludes with others to falsely issue expense receipts; forges, alters, conceals, alters, or destroys medical documents, medical certificates, accounting documents, etc.

Anyone who defrauds medical security fund expenditures by using vouchers, electronic information and other relevant materials, fictitious medical service items, etc. shall be ordered to return it by the medical security administrative department and impose a fine of not less than 2 times but not more than 5 times of the amount defrauded.

At the same time, designated medical institutions are ordered to suspend the medical services involving the use of medical security funds by relevant responsible departments for more than 6 months and less than 1 year until the service agreement is terminated by the medical security agency; those who have professional qualifications shall have their professional qualifications revoked by the relevant competent authorities in accordance with the law.

: For individuals, those who hand over their medical security certificates to others for false use; or repeatedly enjoy medical security benefits; or take advantage of the opportunity to enjoy medical security benefits to resell medicines, accept returns in cash or in kind, or obtain other illegal benefits, shall be subject to medical

The administrative department for security shall order corrections.

Those who cause losses to the medical security fund will be ordered to return it; for insured persons, the online settlement of medical expenses will be suspended from 3 to 12 months.