The contents of the regulations on the supervision and administration of the use of medical insurance funds

Legal analysis: (1) Implementing the requirements of taking people's health as the center and strengthening medical security services. First, the legislative purpose is clearly defined as "strengthening the supervision and management of the use of medical insurance funds, ensuring the safety of funds, promoting the effective use of funds, and safeguarding the legitimate rights and interests of citizens' medical insurance". The second is to establish the principle of using the medical security fund with people's health as the center and following the principles of legality, safety, openness and convenience. The third is to establish and improve a unified national medical security management system and provide standardized and standardized medical security services. Fourth, the designated medical institutions are required to provide medical services according to laws and regulations, improve service quality, rationally use medical security funds, and safeguard citizens' health rights and interests.

(two) clear the responsibility of the relevant subjects in the use of funds, standardize the use of funds. First, the administrative department of medical security should organize and formulate the payment scope of medical security fund according to law, strengthen the supervision of medical services and medical expenses, standardize medical security handling services, and investigate and deal with illegal use of medical security fund according to law. Second, medical insurance agencies are required to establish and improve business, financial, safety and risk management systems, standardize service agreement management, and accept social supervision. Third, the designated medical institutions are required to strengthen internal management, provide reasonable and necessary medical services, save relevant information, transmit data and report regulatory information, and accept social supervision. Fourth, the insured are required to seek medical treatment and purchase medicines with their medical insurance vouchers, enjoy medical insurance benefits according to regulations, have the right to ask designated medical institutions to truthfully issue expense documents and related materials, have the right to ask medical insurance agencies to provide medical insurance consulting services, and put forward suggestions for improvement in the use of medical insurance funds. Fifth, it is forbidden for medical security agencies, designated medical institutions and other units and their staff and insured persons to defraud medical security funds by forging, altering, concealing, altering, destroying medical documents and other related materials or fictional medical services.

(3) Improve the supervision system and strengthen the supervision measures. The first is to build a supervision system that combines administrative supervision by the government and medical insurance administrative departments, supervision by public opinion by news media, social supervision and industry self-discipline. The second is to establish supervision and cooperation mechanisms such as medical security, health and wellness, Chinese medicine, market supervision and management, finance, auditing, public security and other departments, and case transfer. Third, the administrative department of medical security in the State Council is required to formulate measures for the management of service agreements, and to formulate and regularly revise model service agreements. The fourth is to stipulate the forms of supervision such as intelligent monitoring of big data, special inspection, joint inspection and credit management. The fifth is to standardize the measures and procedures of supervision and inspection by the administrative department of medical security.

(4) Refine legal responsibilities and increase penalties. First, if the medical security agency violates the law, it shall be ordered to make corrections, be ordered to return, be fined and punished. Second, the general illegal acts of designated medical institutions shall be ordered to correct, interview the person in charge, be ordered to return, be fined, and be ordered to suspend the medical services of relevant responsible departments for a certain period of time; Designated medical institutions in violation of the management system, shall be ordered to make corrections, interview the person in charge, and impose a fine; Designated medical institutions cheat insurance, shall be ordered to return, fine, ordered to suspend the relevant responsible departments for a certain period of medical services, terminate the service agreement, revoke the qualification; Causing heavy losses to the medical insurance fund or other serious adverse social impacts, the legal representative or principal responsible person shall be restricted from practicing and punished. Third, the illegal individual shall be ordered to correct, be ordered to return, suspend the online settlement of medical expenses for a certain period of time and be fined. Fourth, those who embezzle or misappropriate the medical security fund shall be ordered to recover, confiscate the illegal income and be punished. Fifth, the staff of medical security and other administrative departments shall be punished for abusing their powers, neglecting their duties and engaging in malpractices for personal gain.

Legal basis: Regulations on the Supervision and Administration of the Use of Medical Insurance Funds

Article 3 The use of medical insurance funds shall be centered on people's health, and the level of protection shall be commensurate with the level of economic and social development, and the principles of legality, safety, openness and convenience shall be followed.

Article 4 The supervision and management of the use of medical insurance funds shall combine government supervision, social supervision, industry self-discipline and personal trustworthiness.