The following acts are more than twice the amount of fraud

A fine of less than 5 times

Article 37 and Article 40 of the Regulations point out that if a designated medical institution defrauds the medical security fund in the following ways, the administrative department of medical security shall order it to return it and impose a fine of more than 2 times and less than 5 times the amount defrauded.

1. Inducing or assisting others to seek medical treatment or purchase medicines under false pretenses, providing false certification materials, or colluding with others to falsely issue expense documents;

2. Forge, alter, conceal, tamper with or destroy medical documents, medical certificates, accounting vouchers, electronic information and other relevant materials;

3. Fictitious medical service project;

4, other acts of defrauding the medical insurance fund expenditure.

At the same time, if a designated medical institution commits one of the following acts as stipulated in Article 38 for the purpose of defrauding the medical security fund, it shall be handled in accordance with the provisions of this Article.

second

The amount of loss caused by the accident is more than 1 times.

A fine of less than 2 times

Article 38 of the Regulations points out that in any of the following circumstances, the designated medical institution shall be ordered by the administrative department of medical security to make corrections, and the relevant person in charge may be interviewed; If losses are caused to the medical insurance fund, it shall be ordered to return it, and a fine of 1 times and 2 times shall be imposed; Refusing to correct or causing serious consequences, the designated medical institutions shall be ordered to suspend the use of medical services involved in the medical security fund for more than 6 months and less than 6+0 years; Violation of other laws and administrative regulations shall be dealt with by the relevant competent departments according to law:

1, decomposition hospitalization, hanging bed hospitalization;

2. In violation of the norms of diagnosis and treatment, over-diagnosis, over-examination, prescription decomposition, over-prescribing, repeated prescribing or providing other unnecessary medical services;

3. Repeated charges, over-standard charges and sub-project charges;

4. Exchanging medicines, medical consumables, diagnosis and treatment projects and service facilities;

5, for the insured to take advantage of the opportunity to enjoy medical security benefits to resell drugs, accept cash, return in kind or obtain other illegal benefits to facilitate;

6, does not belong to the medical insurance fund payment scope of medical expenses into the medical insurance fund settlement;

7 other illegal acts that cause losses to the medical insurance fund.

third place

And impose a fine of 1 0,000 yuan but not more than 50,000 yuan.

Article 39 of the Regulations points out that in any of the following circumstances, the designated medical institution shall be ordered by the administrative department of medical security to make corrections, and the relevant person in charge may be interviewed; Those who refuse to make corrections shall be fined 1 10,000 yuan but not more than 50,000 yuan; Violation of other laws and administrative regulations shall be dealt with by the relevant competent departments according to law:

1. The internal management system for the use of medical insurance funds has not been established, or there is no specialized agency or personnel responsible for the management of the use of medical insurance funds;

2. Failing to keep financial accounts, accounting vouchers, prescriptions, medical records, treatment and inspection records, expense details, medicines and medical consumables in and out of storage records and other materials in accordance with regulations;

3, not in accordance with the provisions of the medical insurance information system to transmit data related to the use of medical insurance funds;

4. Failing to report to the administrative department of medical security the information needed for the supervision and management of the use of medical security funds in accordance with the regulations;

5, not in accordance with the provisions of the public medical expenses, cost structure and other information;

6, in addition to emergency, rescue and other special circumstances, without the consent of the insured or their close relatives and guardians to provide medical services outside the scope of payment of medical security funds;

7, refused to medical insurance and other administrative departments to supervise and inspect or provide false information.

fourth

The insured has the following behaviors:

Suspension of online settlement of medical expenses for 3 months to 12 months.

In any of the following circumstances, the administrative department of medical security shall order it to make corrections; Causing losses to the medical security fund, shall be ordered to return; For the insured, the online settlement of medical expenses will be suspended for 3 months to 12 months:

1. Give my medical insurance certificate to others under a pseudonym;

2. Enjoy medical security treatment for many times;

3, take advantage of the opportunity to enjoy medical security benefits to resell drugs, accept cash, physical return or obtain other illegal benefits.

An individual commits one of the acts specified in the preceding paragraph for the purpose of defrauding the medical security fund, resulting in the loss of the medical security fund; Or using another person's medical security certificate to seek medical treatment or purchase medicine; Or by forging, altering, concealing, tampering with, destroying medical documents, medical certificates, accounting vouchers, electronic information and other related materials or fictional medical service items, in addition to being dealt with in accordance with the provisions of the preceding paragraph, the administrative department of medical security shall also impose a fine of not less than 2 times but not more than 5 times the amount defrauded.

In recent years, the state has always held a zero tolerance attitude towards fraudulent insurance. With the "Regulations", medical staff and the insured people will be more aware of what can't be done! Everyone must pay attention in the future, don't step on the thunder!