The Health Insurance Fund is
The people's "money for medical treatment" and "life-saving money"
We need to have zero tolerance
Crack down on insurance fraud
What are the "Ten Prohibitions" and "Five Don'ts" of the Medical Insurance Fund?
Let's find out
1. "Ten Strict Prohibitions" for Designated Medical Institutions
1. It is strictly forbidden to decompose the hospitalization and hang the bed for hospitalization.
2. It is strictly forbidden to over-diagnose and treat, over-examine, decompose prescriptions, over-prescribe drugs, repeat prescriptions, or provide other unnecessary medical services in violation of diagnosis and treatment standards.
3. It is strictly forbidden to charge repeatedly, exceed the standard charge, and decompose the project charge.
4. It is strictly forbidden to exchange medicines, medical consumables, diagnosis and treatment items and service facilities.
5. It is strictly forbidden to facilitate the use of the opportunity of medical security benefits for insured persons to resell drugs, accept the return of cash or goods, or obtain other illegal benefits.
6. It is strictly forbidden to include medical expenses that are not within the scope of payment of the medical security fund into the settlement of the medical security fund.
7. It is strictly forbidden to induce or assist others to impersonate or falsely seek medical treatment or purchase medicines, provide false supporting materials, or collude with others to issue false expense receipts.
8. It is strictly forbidden to forge, alter, conceal, alter, or destroy medical documents, medical certificates, accounting vouchers, electronic information, and other relevant materials.
9. It is strictly forbidden to fabricate medical service items.
10. It is strictly forbidden to deliberately defraud the medical security fund to disburse.
Tips
If the designated medical institution violates the regulations, it will be ordered to make corrections, and return the loss of the medical insurance fund caused, and impose a fine of not less than 1 time but not more than 2 times the amount of the loss; if it refuses to make corrections or causes serious consequences, it shall order the designated medical institution to suspend the medical services related to the use of the medical security fund by the relevant responsible departments for not less than 6 months but not more than 1 year; and if it violates other laws and administrative regulations, it shall be dealt with by the relevant competent departments according to law.
If the medical insurance fund is deliberately defrauded, a fine of not less than 2 times but not more than 5 times the amount of the fraud will be imposed; the designated medical institution shall be ordered to suspend the medical services provided by the relevant responsible departments for not less than 6 months but not more than 1 year until the service agreement is terminated by the medical security agency; and if the person has a professional qualification, the relevant competent department shall revoke the professional qualification according to law.
2. "Five Don'ts" for Individuals to Use Medical Insurance Funds
1. Do not give your medical insurance certificate to others for fraudulent use.
2. You cannot enjoy medical insurance treatment repeatedly.
3. Do not take advantage of the opportunity to enjoy medical security benefits to resell drugs, accept cash or in-kind returns, or obtain other illegal benefits.
4. Do not use other people's medical security certificates to seek medical treatment or purchase drugs in a false name.
5. It is not allowed to defraud the medical security fund by forging, altering, concealing, altering, or destroying medical documents, medical certificates, accounting vouchers, electronic information and other relevant materials, or fictitious medical service items.
Tips
If the insured violates the regulations, not only will the loss of the medical insurance fund be returned, but also the online settlement of medical expenses may be suspended for 3-12 months.
Those who deliberately defraud the medical insurance fund will also be fined 2-5 times the amount of fraud, and those who constitute a crime will be investigated for criminal responsibility in accordance with the law.