This special governance work will comprehensively address illegal activities in designated medical institutions, while focusing on rectifying the "three fake" fraud and insurance issues such as "fake patients", "fake conditions" and "fake bills", as well as designated specialized hospitals, first-level general hospitals, etc.
Medical chaos.
The special governance work aims to use the insurance fraud incident of Taihe Medical Institution as a mirror, resolutely put an end to the unhealthy trend of fraud and insurance fraud, explore the establishment of a strict and powerful medical insurance fund supervision mechanism, and ensure that the majority of insured persons have "medical treatment money" and "life-saving money"
Safe, efficient and reasonable to use.
The focus of this governance involves medical insurance management issues in medical institutions, general violations of laws and regulations, and insurance fraud.
Medical insurance management problems in medical institutions include failure to establish an internal management system for the use of medical security funds, and no specialized agencies or personnel responsible for the management of the use of medical security funds; failure to keep financial accounts, accounting vouchers, prescriptions, medical records, treatment and examination records, expense details, etc. in accordance with regulations.
Records of entry and exit of medicines and medical consumables, etc.
Identity, fake name, fake address.
Anyone who defrauds medical insurance will be fined up to five times.
Starting from May 1, the "Regulations on the Supervision and Administration of the Use of Medical Security Funds" will be officially implemented nationwide.
The "Regulations" clarify the obligations of insured persons for the first time. If an individual, for the purpose of defrauding insurance, gives the medical insurance certificate to others to use it 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 he will be fined for fraud.
A fine of not less than 2 times but not more than 5 times the amount.
In addition, designated medical institutions should also ensure that the fees paid by the medical security fund comply with the prescribed payment scope; except for emergency cases, rescue and other special circumstances, medical services beyond the scope of payment by the medical security fund must be approved by the insured or their close relatives.
, guardian agrees.
It is necessary to gradually increase financial subsidy standards and farmers' individual financing levels based on the financial status of governments at all levels and farmers' income growth and affordability, and actively explore the establishment of a stable, reliable, and reasonable growth financing mechanism.
In 2009, the financing level of the new rural cooperative medical system nationwide will reach 100 yuan per person per year. Among them, the central government will subsidize participating farmers in the central and western regions at a standard of 40 yuan, and provide subsidies to eastern provinces at a certain proportion of the central and western regions; local financial subsidy standards
It should be no less than 40 yuan, and farmers’ individual contributions should be increased to no less than 20 yuan.
The per capita financing level in the eastern region should be no less than that in the central and western regions.
Beginning in 2010, the financing level of the new rural cooperative medical system nationwide has been increased to 150 yuan per person per year. Among them, the central government will subsidize participating farmers in the central and western regions at a standard of 60 yuan, and provide subsidies to eastern provinces based on a certain proportion of the central and western regions; local financial subsidies
The standard will be raised accordingly to 60 yuan, and areas with real difficulties can be divided into two years.
The increased local funds should be mainly borne by provincial finances, and the burden on counties (cities, districts) in need should be minimized.
Individual farmers' contributions will be increased from 20 yuan to 30 yuan per person per year, and in difficult areas the contributions can be paid in two years.
All localities should continue to adhere to the principle of voluntary participation by families, and actively explore new rural cooperative medical individual payment methods that are suitable for local conditions, easy for farmers to accept, and easy to implement.
It can be gradually changed to door-to-door collection by means such as farmers paying on time and at fixed points, entrusting township finance and taxation offices and other institutions to collect on their behalf, villagers committees collecting on their behalf with the consent of the villagers' congress, or financial institutions paying on their behalf through farmers' savings or settlement accounts with the consent of the farmers.
In order to guide farmers to take the initiative to pay, reduce financing costs and improve work efficiency.
It’s best to ask your local medical insurance agency about the standards there.
Legal basis: Article 16 of the "Resident Identity Card of the People's Republic of China" Whoever commits any of the following acts shall be given a warning by the public security organ and shall be fined not more than 200 yuan. If there is any illegal income, the illegal income shall be confiscated: (
1) Using false certification materials to fraudulently obtain a resident identity card; (2) Renting, lending, or transferring a resident identity card; (3) Illegal seizure of another person’s resident identity card.