Legal analysis: 1. Investigate and punish violations of medical price violations included in the scope of medical insurance;

2. Supervision and inspection of medical assistance;

3 .Supervise and inspect the compliance of employers and individuals with social insurance laws and regulations;

4. Strengthen supervision and management of medical services and medical expenses included in the payment scope of the basic medical insurance fund;

< p>5. Supervision and inspection of the compliance of the centralized procurement of high-value medical consumables by public medical institutions;

6. Supervision and inspection of the compliance of the centralized procurement of drugs by public medical institutions;

7. Monitor drug prices and conduct cost surveys;

8. For drug marketing authorization holders, drug manufacturers, drug operating companies and medical institutions to provide their drugs to the drug price authorities Supervision and inspection of actual purchase and sale prices and purchase and sale quantities;

9. Medical insurance audit.

Legal basis: "Notice of the National Medical Security Administration on the Supervision of Medical Security Funds in 2019" 1. Intensify the crackdown and consolidate the high-pressure situation

(1) Supervision and inspection Full coverage. Improve the working mechanism and consolidate the high-pressure situation of fund supervision. Each coordinating region must integrate resources from all parties, concentrate specialized forces, innovate working methods, investigate breaches of contract, violations and illegal activities of designated medical institutions within their jurisdiction one by one, and achieve full coverage of on-site inspections of designated medical institutions. It is necessary to comprehensively use intelligent monitoring, surprise inspections, expert reviews and other methods to bring all medical security fund payments into the scope of post-event review, and accelerate the extension to interception during the event and prior reminders. Provincial medical insurance departments should strengthen overall planning, overall coordination, supervision and inspection, and conduct timely spot inspections of designated medical institutions in the coordinating area, with the proportion of spot inspections not less than 10%.

(2) Carry out special management. On the basis of a comprehensive inspection, a special campaign to combat insurance fraud will be carried out in 2019. Based on the 2018 special action to crack down on fraud and insurance fraud, each province should determine 1-2 special governance priorities based on local realities and weak links, and concentrate its efforts to crack down severely. Before the end of March, study and formulate a unified special treatment work plan for the whole province, and submit it to the National Medical Security Administration for filing; from April to August, each coordinating region will carry out self-examination of special treatment; from September to October, the provincial medical insurance department will conduct random inspections and reviews. , and submit a summary of the special management work to the National Medical Security Administration before the end of November.

(3) Conduct unannounced inspections. The National Medical Security Administration will establish a working mechanism for unannounced inspections, gradually improve the unannounced inspection workflow and operating specifications, and supervise and guide local work through unannounced inspections from time to time. After receiving the unannounced inspection notice, all provincial medical insurance departments must strictly enforce work discipline, actively cooperate with the inspection, and complete the follow-up investigation and handling of the unannounced inspection as required.

(4) Highlight the key points of attack. According to the characteristics of frequent and high-occurrence violations of different supervision objects, focus on key points, classify crackdowns, and implement corresponding measures. For designated medical institutions, it is necessary to further determine the focus of supervision according to their service characteristics. Public medical institutions at level 2 and above will focus on investigating and punishing decomposed charges, excessive charges, repeated charges, charged items, unreasonable diagnosis and treatment, and other violations; primary care Institutions, focus on investigating and punishing behaviors such as hospital admission, exchanging medicines, consumables, and diagnosis and treatment items; private medical institutions, focusing on investigating and punishing behaviors such as inducing hospitalization of insured persons, fabricating medical services, forging medical documents and bills, hospital admission, stealing social security cards, etc. . Targeting designated retail pharmacies, we will focus on investigating and punishing activities such as stealing social security cards and inducing insured persons to purchase cosmetics and daily necessities. For insured persons, we will focus on investigating and punishing forging false bills for reimbursement, seeking medical treatment under false names, using social security cards to cash out or obtain medicines and consumables, etc. For medical insurance agencies (including commercial insurance agencies that undertake basic medical insurance and critical illness insurance), it is necessary to strengthen supervision and inspection, focusing on investigating and punishing imperfect internal audit systems, incomplete fund audits, inadequate contract performance inspections, illegal processing of medical insurance benefits, and illegal payment of medical insurance. Expenses, as well as internal personnel's "stealing", "internal and external collusion" and other behaviors.