Measures of Zhuhai Municipality on Anti-fraud of Social Insurance

chapter I general provisions article 1 in order to ensure the safety and integrity of social insurance funds in this municipality, correct and investigate social insurance fraud, and standardize the anti-fraud work of social insurance, these measures are formulated in accordance with relevant laws and regulations and combined with the actual situation of this municipality. Article 2 These Measures shall apply to the anti-fraud work of social insurance such as endowment insurance, medical insurance, unemployment insurance, industrial injury insurance and maternity insurance in this Municipality. Article 3 The municipal and district administrative departments of labor and social security (hereinafter referred to as the administrative departments of labor security) shall be responsible for the anti-fraud work of social insurance. Article 4 The term "fraud" as mentioned in these Measures refers to the acts of citizens, legal persons or other organizations in the process of participating in social insurance, paying social insurance premiums and enjoying social insurance benefits, such as practicing fraud and concealing the real situation.

Anti-fraud as mentioned in these Measures refers to the actions of relevant government departments such as labor security and taxation to prevent, investigate and deal with social insurance fraud according to law.

The anti-fraud department of social insurance and anti-fraud staff mentioned in these Measures refer to the relevant government functional departments such as labor security and taxation, and the staff in these departments who are qualified for administrative law enforcement and hold administrative law enforcement certificates. Article 5 Anti-fraud work shall follow the principles of objectivity, fairness, impartiality and legality. Sixth social insurance anti-fraud work required funds included in the fiscal budget at the same level. Chapter ii responsibilities and authorities article 7 responsibilities of the administrative department of labor security:

(1) to formulate policies related to social insurance anti-fraud and supervise their implementation.

(2) to guide and coordinate anti-fraud work.

(3) accepting reports and complaints about social insurance fraud.

(4) investigate and deal with major fraud cases.

(5) imposing administrative penalties on the parties involved in fraud cases.

(6) transferring fraud cases that should be handled by other relevant government departments.

(7) reward informants. Article 8 the responsibilities of social insurance agencies:

(1) to check the participation of employers in various social insurances and the enjoyment of social insurance benefits by insured individuals.

(2) Sign medical service agreements with hospitals, outpatient departments, pharmacies and other designated social insurance medical service institutions to standardize the service behavior of medical service institutions.

(3) to certify the qualifications of persons receiving social insurance benefits, and to inspect designated medical institutions and pharmacies.

(4) accepting reports and complaints about social insurance fraud.

(5) investigate and collect evidence on suspected fraud, and order the illegal income to be returned to the social insurance pooling fund.

(6) For serious fraud cases, hand them over to the administrative department of labor security. Article 9 the responsibilities of the labor security supervision organization:

(1) to supervise the employer's participation in various social insurances and payment of social insurance premiums.

(2) accepting reports and complaints about social insurance fraud.

(3) Correcting and investigating social insurance fraud cases. Article 1 the duties of the local tax authorities:

(1) to be responsible for inspecting the misrepresentation, concealment and omission of payment units and individuals in the process of paying social insurance premiums.

(2) provide data and materials related to social insurance anti-fraud to the administrative department of labor security on a regular or special basis. Article 11 the responsibilities of the public security department:

(1) the social insurance fraud cases transferred by the administrative department of labor and social security that are suspected to constitute crimes shall be investigated.

(2) The insured whose household registration has been cancelled shall provide the cancellation information of household registration to the social insurance agency within 3 working days. Article 12 The departments of finance, health, drug supervision, civil affairs, industry and commerce, prices, personnel and streets (towns) shall cooperate with the investigation and evidence collection of social insurance anti-fraud work, and assist in recovering the social insurance benefits that are falsely claimed. Article 13 when performing their duties, social insurance anti-fraud staff may exercise the following functions and powers:

(1) to enter relevant production and business premises for investigation.

(2) Asking questions related to the suspected fraud case regarding the investigation.

(3) require the relevant parties to provide financial statements, employee files, medical records and other documents related to the suspected fraud case, and make explanations and explanations.

(4) Collect relevant information and materials by consulting, recording, audio recording, video recording, photographing or copying.

(5) to correct or stop the fraud suspects from concealing, forging, altering or destroying relevant documents and financial statements.

(6) other functions and powers as prescribed by laws and regulations. Fourteenth social insurance anti-fraud staff should be loyal to their duties, enforce the law impartially, be diligent and honest, and keep secrets.

if the suspected fraud case investigated by the social insurance anti-fraud staff has a direct interest in himself or his close relatives, he should withdraw. Fifteenth people who receive social insurance benefits lose their conditions, and their relatives, other interested parties or local community organizations should report to the social insurance agency within 3 working days. Article 16 The anti-fraud department of social insurance may entrust an accounting firm, an auditing firm and other social intermediary agencies to conduct professional auditing on the financial status of the investigated object in a suspected fraud case. Chapter III Fraud Article 17 The following acts of payment units and individuals are fraudulent:

(1) Forging or altering social insurance registration certificates.

(2) failing to truthfully declare the number of employees, payment wages and other information.

(3) forging, altering, intentionally destroying account books and materials related to social insurance, or not keeping account books, so that the base of social insurance payment cannot be determined.

(4) other fraudulent acts that violate social insurance laws, regulations and policies.