Seeking the experience, hot spots and difficulties in the process of medical insurance inspection

Experience of medical insurance inspection

195 "Two Rivers" has been piloted for 10 years. 10 years, the team of medical insurance, a new thing, has been growing. No matter the insured, the insured units, or the designated medical institutions and retail pharmacies of medical insurance are developing rapidly, especially the rapid increase of designated medical institutions and retail pharmacies, on the one hand, it is convenient for the insured workers to seek medical treatment and purchase medicines. On the other hand, due to market competition, the illegal activities of designated medical institutions and retail pharmacies are increasing day by day, which also encourages some insured persons with ulterior motives to defraud and extract medical funds, posing a great threat to the safe operation of medical funds. It is imperative to strengthen the supervision and inspection of medical insurance.

When Huishan District 200 1 was established, there were only10.9 million employees, 4 designated medical institutions 14 and 4 designated retail pharmacies. Up to now, there are 65,000 insured employees, 34 designated medical institutions and 39 designated retail pharmacies in the region. From the violations investigated, it can be found that 0 1 only has single violations such as unreasonable charges and nominal outpatient hospitalization, while the violations in 2004 were universal, hidden and diverse, posing a certain threat to the fund's operation safety.

To carry out targeted medical insurance inspection, we must have a comprehensive understanding of the current violations. First, an in-depth analysis of medical insurance violations is conducive to the smooth development of medical insurance inspection.

Analysis of medical insurance violations

The participants and components of medical insurance are mainly medical insurance agencies, designated medical institutions, retail pharmacies and insured employees. The main targets of medical insurance inspection are designated medical institutions, retail pharmacies and medical insurance participants, and the main implementers of medical insurance inspection are medical insurance agencies.

From the perspective of fund composition, the medical insurance fund is mainly divided into four parts: individual account fund, overall medical fund, supplementary medical fund and civil servant medical subsidy. There are different ways to violate the rules around different funds, sometimes it is a relatively independent violation mode for a certain fund, and some are interrelated violations.

It is more helpful to analyze all kinds of illegal behaviors from the part of medical insurance participation and the part of medical insurance fund to check the pertinence and effectiveness of the work.

I. Personal account violation

Personal account violations mainly occur in outpatient clinics and retail pharmacies of designated medical institutions, which are mainly manifested as: empty medical funds, changing medicines with medicines, exchanging medicines for things, etc.

Due to the strict scope of medical insurance, medical insurance personal accounts can only be used for drugs, materials, treatment and diagnosis and treatment projects in the medical insurance catalogue. In order to earn more profits, designated medical institutions and retail pharmacies take risks and illegally include drugs, articles, materials, treatments and diagnosis and treatment items that are not allowed in the medical insurance catalogue into personal accounts of medical insurance.

The violations are mainly as follows:

1. Modify the project name and change the non-medical insurance project into the medical insurance catalogue project.

2. Exchange prescriptions, replace prescriptions with medical insurance drug prescriptions, and make up the same number of prescriptions.

3. Falsely prescribe drugs, materials, diagnosis and treatment, and withdraw funds from medical insurance personal accounts to exchange goods or even cash out.

4. Decompose prescriptions, and take decomposition measures for excessive prescriptions to avoid the risk of violation.

Second, it violates the overall fund.

The overall fund is mainly used for hospitalization and serious illness. Because the settlement method is mainly based on disease settlement and quota settlement, the violations are mainly concentrated on hospitalization quota and disease. There are several ways to violate the overall fund:

1, decompose hospitalization quota

2. Reduce the admission criteria and increase the number of admission places.

3, false hospitalization, defrauding hospitalization places.

4. Take a fake disease on the disease, or avoid the heavy weight and focus on the diseases with high quota.

Three. Violation of civil servants' supplementary medical care and Medicaid

Violations of supplementary medical care and Medicaid for civil servants are basically violations of outpatient services. After the personal account is used up, the specific use methods and scope of supplementary medical care and Medicaid for civil servants are different, but they are basically expenses incurred in outpatient clinics, so the violations are basically similar to those for personal accounts.

Fourth, other violations.

Other violations mainly focus on illegal charges. Due to the variety of medical charges and the emergence of new medical technologies, medical charges are often opaque, overcharged, repeated and not charged according to the price regulations.

In view of the above violations, effective audit means are needed to ensure the safe and stable operation of medical funds. Through the experience accumulated in daily audit work, the following audit methods are summarized:

1, always grasp the dynamic information of medical insurance operation.

The dynamic information of medical insurance mainly refers to the operation information of medical insurance in designated medical institutions and retail pharmacies, the medical information of insured patients and the information of medical charges.

Establishing a perfect medical insurance information system is the basis of mastering the dynamic of medical insurance information. Only by mastering the information dynamics of medical insurance at any time can we check the violations in a targeted manner.

If the outpatient or inpatient visits and expenses of designated medical institutions or retail pharmacies increase abnormally, the medical insurance information system can be used to understand the insured's medical treatment, medication and treatment. In view of these situations, we can carry out some targeted inspections, check the beds of hospitalized patients to see if there is any nominal hospitalization, and check the drug use of an insured patient, what drugs he used and whether there is any fake prescription.

Relying on the medical insurance information system, we can have a comprehensive and general understanding of the violations and make the inspection more targeted.

2. Proficient in business knowledge

Skilled professional knowledge is the basis of inspection work. You must have good professional quality when you understand the violations, so that the inspection work can be carried out smoothly.

Good professional quality requires us to be proficient in computer knowledge, financial knowledge, basic medical knowledge and management knowledge. Only in this way can we become a qualified medical insurance inspector.

Computer knowledge can make us really understand the operation of medical institutions and retail pharmacies, as well as the medication and diagnosis and treatment of insured people. Financial knowledge can help us understand the ins and outs of the use of medical funds, whether it is reasonable, whether it has been taken and misappropriated. Basic medical knowledge can let us clearly understand the whole diagnosis and treatment process, whether there are unreasonable places and whether there is a "ride" phenomenon. Management knowledge can enable us to correctly guide the designated medical insurance institutions to operate reasonably and standardize, and provide quality services for insured employees.

3. Strengthen management and standardize medical insurance services.

Standardized management is an effective means to prevent violations. We have signed service agreements with designated medical institutions and retail pharmacies, which stipulate the rules that designated medical institutions and retail pharmacies must abide by to provide quality services for insured employees. On this basis, it is necessary to establish an exit mechanism, and resolutely cancel the designated qualification and terminate the service agreement for designated medical institutions and retail pharmacies that seriously violate the rules and refuse to change.

4, master the rules of violation, regular and irregular spot checks.

Violation of rules has its inevitable laws. Only by mastering the laws can the inspection work be more effective and powerful. For example, in view of the violation of the plan by designated retail pharmacies, most of them open stores in the morning and close them at night, so we will take night inspections and morning inspections to catch violations. For another example, nominal hospitalization and decomposition hospitalization often do not exist. As soon as we get the hospitalization information, we will check the beds and know if there are any vacant beds. Decompose hospitalization, and the insured patients will be hospitalized a few days after discharge, and it is the same disease. As long as we check the hospitalization interval, the interval is very short, and it is easy to find out that it is a breakdown of hospitalization and so on.

Inspection work is a complicated and changeable work. It is necessary to keep abreast of the violation trends and master the violation information, so as to do a better job in medical insurance inspection and better ensure the safe and stable operation of medical funds.

New achievements have been made in social insurance fund management and social insurance inspection (verification) in Shandong Province.

2004/5/ 1 1

Comrade Yan Jinlong is engaged in social insurance fund management and social insurance inspection (verification) in the province.

Speech at the meeting (excerpt)

First, the province's social insurance fund management has made new achievements.

In 2003, under the leadership of the Party Committee and the government, and under the guidance of Theory of Three Represents, the labor and social security departments at all levels in the province conscientiously implemented the spirit of the 16th National Congress and the Third Plenary Session of the 16th Central Committee, emancipated their minds, made pioneering efforts, accelerated development, and successfully completed the task of social insurance fund management.

(1) The income of various social insurance funds increased steadily, and the fund balance continued to increase. Focusing on the long-term development of social security, all localities have taken the expansion of collection as an important measure to enhance the fund's security capacity, which has realized the synchronous growth of the number of participants, the number of payers and the fund's income, and further enhanced the fund's ability to pay.

(two) to ensure the timely payment of social insurance benefits. Last year, the province spent 27.85 billion yuan on various social insurance funds, an increase of 1 1% over the previous year. 2 193000 retirees from enterprises and institutions in the province receive pensions in time; 476,000 unemployed people received unemployment insurance and received vocational training in time, and 360,000 people were re-employed; 69 1. 1 10,000 people participate in medical insurance and enjoy medical insurance benefits; 6 183000 people participated in industrial injury and maternity insurance. Through the joint efforts of provinces, cities and counties, all social insurance benefits were paid in full and on time, and no new arrears occurred.

(3) Increase the adjustment of funds. In view of the unbalanced economic development in various regions and the fact that some cities and counties' funds can't meet their expenditures, our province timely allocated enterprise pension insurance and unemployment insurance adjustment funds. Some cities have also made overall adjustments to the funding gap in their districts and counties. The timely disbursement of funds at the provincial and municipal levels has strengthened the fund adjustment mechanism and played an important role in making up the fund gap in some places and ensuring payment.

(4) The financial management of funds is further standardized. Carry out the revenue and expenditure operation of social security funds according to law, improve the fund management mechanism, establish and improve the management system, and standardize management behavior. Strengthened the whole process management of financial work such as budget, raising, storage, payment, accounting, operation analysis, supervision and inspection. The accounting statement system has been improved, and the timeliness, accuracy and standardization of financial analysis have been realized. Strictly implement the financial system of social insurance funds and clean up fund accounts that do not meet the requirements. All social insurance funds have reasonable income, appropriate expenditure and orderly management, which improves the management level, ensures the safety of funds and prevents the phenomenon of misappropriation and misappropriation of funds.

Two, the province's social insurance inspection (nuclear) work has achieved new results.

Last year, the Ministry of Labor and Social Security issued the Measures for Social Insurance Auditing, and the provincial government issued the Measures for Social Insurance Auditing in Shandong Province, marking a new development period for social insurance auditing. All localities conscientiously study and implement the two "Measures" and comprehensively carry out social insurance inspection (nuclear) work.

The development of social insurance inspection has effectively maintained the social insurance work order, enhanced the legal awareness of employers to pay insurance premiums and receive social insurance benefits according to law, standardized the payment behavior of insured units, and played an extremely important role in expanding social insurance coverage, promoting the collection of social insurance premiums and protecting the legitimate rights and interests of insured persons. Various localities have also accumulated many successful experiences and practices in the inspection (nuclear) work:

(a) understanding in place, strong organization and leadership. Labor and social security departments at all levels and social insurance agencies regard inspection (verification) as an integral part of deepening the reform of the social insurance system and accelerating the improvement of the social security system, and put it in an important position and incorporate it into the annual work goal, so as to achieve "five in place" in terms of ideological understanding, leadership organization, personnel training, methods and measures, and publicity and education. All cities have set up inspection leading groups, social insurance agencies above the municipal level have basically set up special inspection (nuclear) working institutions, and social insurance agencies at the city and county levels are equipped with full-time or part-time inspection (nuclear) personnel. At the same time, all localities take training to improve the quality of inspection (nuclear) personnel as an important task, organize inspection (nuclear) personnel to learn relevant policies and regulations, learn relevant professional knowledge, conduct professional ethics, integrity and inspection discipline education, and require inspection personnel to master the contents, methods and procedures of inspection work, be familiar with the rights and obligations of inspection, and strengthen the construction of ideological style. In order to cooperate with the inspection (nuclear) work, various localities have adopted flexible and diverse forms and launched publicity activities with great fanfare, creating a good public opinion atmosphere.

(2) overall linkage and comprehensive promotion. This is one of the successful experiences of social insurance inspection (verification) in our province. First, cities, counties (districts) are linked up and down, and the work plan, work deployment, inspection content, inspection time, inspection methods and work procedures are "six unified" to promote regionalization as a whole. Second, all types of insurance work together. In view of the fact that the payment targets and payment bases of some insurance products are the same, relevant insurance institutions jointly form an inspection team to conduct centralized inspections on the insured units, and the number and base of payment are uniformly approved, which improves the inspection efficiency and avoids repeated inspections. The third is the overall linkage between inspection work and social insurance related work. Linkage between inspection and collection, inspection and debt settlement, inspection and prevention of fraudulent insurance, inspection and social insurance fund management, inspection and social insurance publicity, inspection and improvement of social insurance basic work, etc. Various forms of linkage mechanism make social insurance inspection and various social insurance work organically combined and comprehensively promoted, and the function of social insurance inspection is fully exerted, which also effectively promotes the development of various social insurance work.

(3) Improve the system and standardize the operation. In order to strengthen and standardize the inspection work, the Ministry of Labor and Social Security and the provincial government have successively promulgated the Measures for Social Insurance Inspection and the Measures for Social Insurance Inspection in Shandong Province. The Provincial Department of Labor and Social Security has issued a series of documents, and various localities have also issued standardized working systems in light of local conditions. In the inspection work, all localities have strengthened the concept and awareness of the legal system, adhered to the independence, impartiality and prudence of inspections, made the inspection objects, contents, procedures and results "four open", administered according to law, acted in strict accordance with law enforcement procedures, standardized the format of inspection documents, and filed the filing materials in time, which further improved the level of legalization of inspection work.

(four) grasp the policy, check and correct. All localities strictly implement social insurance laws, regulations and policies in inspection work, seriously correct illegal acts, recover social insurance premiums, and adhere to the combination of inspection and publicity and education, inspection and help rectification, inspection and correction of illegal acts, and inspection and recovery of insurance premiums. Deal with the problems found out separately, resolutely recover the underpaid insurance premium and the insurance premium falsely claimed, promote the collection and payment of social insurance premiums, and reduce capital losses.

While fully affirming the achievements, we should also see that there are still some difficulties and problems in our work. Mainly manifested in: the laws and regulations of social insurance fund management are not perfect, and the fund management lacks legal protection; The sources of funds are few, the structure is unreasonable, and it is difficult to pay funds in some places; The management system is not smooth and the responsibilities between departments are not clear. In the social insurance audit (nuclear) work, it is found that the underpaid social insurance premium is difficult to recover and repay, and the means of restriction are weak; Some cities and counties labor and social security departments and agencies pay insufficient attention to the inspection (nuclear) work, and the organization is weak and the work is not meticulous; Some cities and counties have no special inspection (nuclear) institutions, lack of personnel, shortage of funds, backward working methods and so on. All these need to be carefully studied and solved in our future work.

Three, emancipate the mind, pioneering and innovative, to achieve a new breakthrough in social insurance fund management and social insurance inspection (nuclear).

This year is the first year to fully implement the spirit of the Third Plenary Session of the 16th CPC Central Committee. Labor and social security departments at all levels and social insurance agencies should firmly establish and conscientiously implement the Scientific Outlook on Development, and comprehensively do a good job in this year's social insurance fund management and social insurance inspection (verification) in accordance with the deployment and requirements of the provincial labor and social security work conference:

(a) improve the social insurance fund raising mechanism, raise funds through multiple channels, and consolidate and guarantee the payment results. We should continue to put the timely payment of social insurance benefits in the first place in labor security work, take active and effective measures, and earnestly implement them. At present, the single financing channel is the main bottleneck restricting the income growth of social insurance funds in our province. Social insurance premiums paid by insured units and individuals in our province account for more than 95% of the total income of the fund, which is the main source of social insurance funds in our province. To raise social insurance funds through multiple channels, we must first do a good job in the management of social insurance premium collection income. Efforts will be made to expand the coverage of social insurance, increase the collection and payment, and ensure the sustained and steady growth of fund income and accumulation. At present, there are some financial difficulties at all levels, and it is difficult for social insurance funds to fully compensate. We should take expanding the collection and payment as the most realistic and effective measure to supplement the social insurance fund and improve the social security system, and strive to improve the self-balancing ability of the fund.

Secondly, we should conscientiously do a good job in the basic management of social insurance. Within the overall scope of the insured units and individuals, the number of employees, payment base, financial status, payment ability, etc. To check and verify one by one, find out the base, establish and improve the payment records, timely grasp the collection income, timely reminders.

The third is to improve the collection methods and means, formulate and improve relevant policies and regulations in view of the new situation and new characteristics under the conditions of socialist market economy, standardize the payment behavior according to law, and collect fees according to law. The combination of reporting payment and social insurance inspection (verification), voluntary payment and compulsory collection according to law, timely payment and late payment penalty should not only strengthen positive publicity, but also increase the punishment for illegal acts, rectify and standardize the social insurance work order and create a good legal environment.

Fourth, gradually improve the level of overall planning and improve the adjustment mechanism of social insurance funds. Provincial and municipal levels should seriously study and improve the fund adjustment mechanism, enhance macro-control ability, rationally allocate funds, and increase adjustment efforts. Adhere to the fund transfer system, and local surplus funds should be transferred regularly according to regulations. Some local funds have difficulties in paying, so they should be adjusted from the overall fund on the basis of strict assessment of their work to make up for their lack of funds, help them tide over the difficulties, maintain social stability and promote economic development. At the same time, actively strive for the support of financial departments at all levels, increase the structural adjustment of fiscal expenditure, and arrange and allocate funds in full and on time.

(2) Improve the fund management mechanism and further standardize the fund management behavior. In recent years, the scale and total accumulation of social insurance funds in our province have increased year by year. Managing and using this huge sum of money well is related to the stable operation of the social insurance system in our province and the vital interests of the masses, which is related to the overall situation and has great responsibilities.

All localities should adapt to the changes in the social insurance situation, conscientiously sum up past experience, constantly improve management methods, and establish a scientific and effective management mechanism. It is necessary to strictly implement the financial system and accounting system of social insurance funds, strengthen fund income management, expenditure management and balance fund management, and ensure that the fund's financial revenue and expenditure are reasonable, the accounts are clear, and the data information is accurate and timely. It is necessary to improve and perfect the specific provisions and rules and regulations of fund management, strictly implement the provisions of separating income and expenditure of social insurance funds and storing them in state-owned commercial banks, and recover the funds previously lent and misappropriated. The newly misappropriated funds should be investigated for responsibility and dealt with seriously.

We should strengthen the scientific management of funds. To manage and use the fund well, we should not only manage and control the fund well to ensure its safety, but also manage and use the fund well. According to the current policies and regulations, arrange expenditures reasonably, use funds effectively, and strive for the best social and economic benefits in the use of funds. It is necessary to study and formulate effective measures, coordinate relevant departments, and realize the preservation and appreciation of the fund. It is necessary to strengthen the financial analysis and benefit analysis of the fund, track the benefits, better understand and master the operating rules of fund revenue and expenditure management through analysis, and further improve the fund management level.

It is necessary to improve the internal control and supervision mechanism of social insurance fund management. Establish and improve a series of supervision mechanisms such as financial management post setting, personnel function division, financial management organization and implementation, internal control system, etc., and supervise the whole process of fund financial activities. It is necessary to scientifically use financial control and supervision means, take effective forms, combine daily supervision with special supervision, and combine pre-supervision, in-process supervision with post supervision, so as to timely find out behaviors that violate the financial system and financial discipline, and promptly correct and deal with them.

(3) Intensify publicity and conscientiously implement the two measures. Last year, the Ministry of Labor and Social Security and our province promulgated the Measures for Social Insurance Inspection and the Measures for Social Insurance Inspection in Shandong Province, which clearly stipulated the inspection of the implementation of the social insurance system and the handling of related illegal acts, providing a legal basis for social insurance inspection. The implementation of the two "Measures" is of great significance for strengthening and standardizing the inspection (verification) of social insurance, protecting the legitimate rights and interests of workers and promoting the healthy development of social insurance. All localities should continue to carry out extensive and in-depth study and publicity activities, deeply understand the great significance of the promulgation and implementation of the two measures, accurately grasp the basic content and spiritual essence, and enhance the consciousness of implementation. It is necessary to go deep into enterprises, units, streets and communities, publicize the insured units and relevant personnel in a targeted manner, urge them to enhance their legal concept, consciously fulfill their responsibilities and obligations to participate in social insurance, standardize the payment behavior, and care for and support the inspection work.

(four) continue to carry out in-depth social insurance inspection (nuclear). According to the work arrangement of the Ministry of Labor and Social Security, combined with the reality of our province, the ministries and agencies have determined to check all the insured objects in the first three years, and since 2004, it will take three years to check the insurance payment of all kinds of insured units and individuals in the province again; In 2004, the number of on-site inspections in various places was not less than1/3 of the insured; This year, a comprehensive verification will be conducted on the situation of retirees receiving pensions from enterprises, institutions and institutions; Carefully check the payment of medical care, unemployment, work injury and maternity insurance benefits.

The inspection of the payment of medical insurance benefits should be based on the agreement, with the computer network system as the means, and the spot check should be combined with the daily inspection and assessment. For designated medical institutions, it is necessary to check whether the fees exceed the standard, whether the non-medical insurance items are included in the scope of fund payment in disguise, whether there is a phenomenon of prescribing drugs, repeating prescriptions or exceeding the standard, and whether there is collusion between internal employees and doctors and patients. For designated retail pharmacies, focus on checking the out-of-range drug use. At the same time, it is necessary to focus on monitoring and reviewing the abnormal situation of high frequency and high cost of outpatient medical treatment for insured personnel. In order to strengthen the inspection of medical insurance, the Social Security Center of the Ministry of Labor and Social Security will hold a special seminar in the second half of the year, and the Fund Audit Management Office of the Provincial Social Security Bureau will also strengthen research, select some cities as key contact points, and summarize local experience for promotion.

It is necessary to closely combine the inspection (nuclear) work with the expansion, collection, settlement and prevention of fraudulent use, so as to promote the comprehensive and coordinated development of social insurance work. In the past three years, the audit work in our province has played an important role in rectifying and standardizing the social insurance work order, promoting the collection and payment, and preventing the false application of social insurance benefits. Doing a good job in inspection (nuclear) and promoting the expansion of collection and payment is promising. Social insurance inspection (verification) is a statutory function entrusted by the state and provincial governments to the labor and social security departments and social insurance agencies. Social insurance agencies at all levels should fully perform this function, straighten out the working relationship and make a difference. Inspection work should be included in the annual work plan, and be deployed, implemented and assessed together with the expansion, collection and payment. The number and base of payment should be approved, and the insured units should be publicized to the employees. It is necessary to regularly check the payment of insurance premiums, timely check the personnel receiving insurance benefits and related information, and promptly investigate and deal with problems found and reported by the masses. Internal institutions such as inspection agencies and the audit of collection and payment treatment should closely cooperate and coordinate, perform the overall functions of social insurance work, "increase revenue and reduce expenditure", realize the collection and payment of social security funds, and plug the loopholes of fund loss.

(five) according to the law (nuclear), according to the law. Social insurance inspection (verification) is an administrative law enforcement activity. Labor and social security departments at all levels and social insurance agencies must strengthen the concept of the legal system, strictly abide by law enforcement procedures, and carry out inspections according to law. In determining the object of investigation, investigation and evidence collection, examination and approval, and other key links, leaders should strictly control and collectively study and decide on major issues to avoid violating legal procedures and abusing their powers. Inspection documents should be standardized in format, complete in content, timely in delivery and complete in procedures. After the inspection, relevant information should be carefully sorted out and filed. It is necessary to strictly enforce the law, and truly abide by the law, strictly enforce the law, and correct violations. The illegal acts found in the inspection shall be ordered to make corrections within a time limit; Should be given administrative punishment, it should be punished according to law; If a crime is constituted, criminal responsibility shall be investigated by judicial organs. For those who conceal the unpaid social insurance premiums and fail to make corrections within the time limit, in addition to paying the unpaid insurance premiums, they shall be charged a late fee according to law, and the directly responsible person in charge and the responsible person shall be punished. Do not meet the conditions for enjoying insurance benefits, defraud social insurance benefits, etc. , ordered to return within a time limit, and shall be investigated for the responsibility of the relevant personnel. It is necessary to adhere to the principle of combining punishment with education, do a good job in publicizing and interpreting laws and regulations during inspection, and enhance the consciousness of participating units and employees to know and abide by the law.

(six) to establish and improve the inspection (nuclear) institutions and build a high-quality inspection (nuclear) team. Strengthening the construction of inspection (nuclear) institutions is the organizational guarantee for carrying out social insurance inspection. Last year, the Ministry of Labor and Social Security issued a document [2003] No.32, requiring municipal social insurance agencies to establish special audit institutions in principle, and county-level social insurance agencies should be equipped with full-time auditors. All localities should conscientiously implement the spirit of the document of the Ministry of Labor and Social Security and earnestly do a good job in the construction of social insurance inspection (nuclear) institutions. If there is no special inspection organization, we should actively strive for the support of local party committees, governments and relevant departments, establish and improve the inspection (nuclear) working organization as soon as possible, and deploy personnel with high political and professional quality to enrich the inspection (nuclear) team; If the inspection (nuclear) work organization has been established, it is necessary to adjust the allocation of full-time personnel to ensure the inspection (nuclear) work needs. Do a good job in training inspectors (nuclear inspectors) and improve the level of administrative law enforcement inspection (nuclear inspectors). It is necessary to adhere to the combination of centralized training and regular training, and take various forms such as training by meeting, observation and demonstration, and case analysis. Strengthen the training of inspection personnel's ability and quality, so as to continuously improve it. This year, the province plans to organize centralized training for the heads of municipal organs and inspectors in stages. Municipalities should also do a good job in training the heads and inspectors of county-level institutions. It is necessary to strengthen the management and education of inspectors, strictly abide by the discipline of inspection work, correctly exercise their rights, strengthen their sense of service, consciously accept the supervision of the masses, and establish a good image of social insurance inspection.

(seven) pioneering and innovative, the establishment of social insurance inspection (nuclear) long-term mechanism. At present, China is in the process of profound economic system reform and strategic adjustment of economic structure. Establishing and perfecting a social security system that is compatible with the level of economic development is not only an inevitable requirement for building a well-off society in an all-round way and developing a socialist market economy, but also a fundamental plan for maintaining social stability and long-term stability of the country. It is necessary to proceed from the needs of the long-term development of social security, take into account both the present and the long-term, and innovatively establish a long-term mechanism for social insurance inspection (verification) on the basis of doing a solid job at present.

It is necessary to actively explore the establishment of a credit system for payment by insured units. Establishing the unit payment credit system is an important part of establishing the social credit system, which is of great significance for promoting the insured to pay in full and on time, guiding the workers to safeguard their rights according to law and improving the management level of social insurance. The unit payment credit system is a system in which social insurance agencies exercise the inspection function according to law, check and verify the insured units' compliance with social insurance laws and regulations and the declaration and payment of social insurance premiums, divide different credit grades according to their honesty and trustworthiness, and implement classified supervision. It is necessary to establish the credit records of enterprises to fulfill their payment obligations, establish and improve the enterprise credit information database, implement networking and information exchange where conditions permit, fully integrate and utilize various information resources, establish a fair, open and efficient audit information system, and select "social insurance payment credit units" to be commended; Take records, warnings, warnings, penalties and other means to urge the untrustworthy units to correct. Recently, the Social Security Center of the Ministry of Labor and Social Security has formulated and issued the Guiding Opinions on Promoting the Construction of Enterprise Social Insurance Credit System (Draft for Comment), which will be officially issued after revision. According to the deployment of the Ministry of Labor and Social Security, our province will also establish and implement the credit system of unit payment on the basis of earnestly studying the advanced experience of other provinces and in-depth investigation and study, so as to promote the insured units to pay social insurance premiums in full and on time.

It is necessary to give full play to the role of the news media and mobilize social forces to supervise the payment of units. Give full play to the role of radio, television, newspapers, magazines and other news media, not only vigorously publicize the units that pay insurance premiums according to law, but also improve their visibility; It is also necessary to expose the negative examples of refusing to participate in social insurance, concealing the number of payers and salary base, underpaying social insurance premiums and harming the rights and interests of employees, creating a glorious environment and atmosphere for paying fees according to law, mobilizing public opinion to care for and support social insurance work, and supervising the payment behavior of enterprises.