The State Department has issued new rules on health care! These acts should be severely punished!

On February 20th, the Chinese government issued the Regulations on the Supervision and Administration of the Use of Medical Security Funds (hereinafter referred to as the Regulations on Administration), which aims to strengthen the supervision and management of the use of medical security funds, ensure the safety of funds, promote the effective use of funds and safeguard the legitimate rights and interests of citizens' medical security.
As China's first regulation in the field of medical insurance, the Regulations have been fully deployed with 50 specific elements from the five aspects of general rules, fund use, supervision and management, legal liability and by-laws, and will come into effect on May 1, 2021.
establishing a collective bargaining and consultation mechanism as a strategic purchaser, the State Health Insurance Administration, since its establishment in May 2018, has gradually promoted the legal construction of medical security under the deployment of top-level decision-making, and established and improved the legal system for medical security.
In addition to the preparation of the Legislative Plan of the National Health Insurance Administration (2018-2022) and the Measures for the Administration of Legislative Work of the National Health Insurance Administration (Trial), the National Health Insurance Administration is also promoting the construction of an independent and complete medical security legal system supported by the Medical Security Law, supported by a number of supporting administrative regulations and sectoral regulations.
the principle of urgency first, the Regulations have become the primary legislative work of the National Health Insurance Administration to promote the overall and system-wide efforts.
The Regulations emphasize in the general rules that the use of medical security funds adheres to the people's health as the center, that the level of protection is appropriate to the level of economic and social development, and that the principles of legality, safety, openness and people-to-people are followed, while the supervision and management of the use of medical security funds is combined with government supervision, social supervision, industry self-discipline and personal trustworthness.
In addition to clarifying that the use of medical security funds should conform to the scope of payment prescribed by the State and that the scope of payment of medical security funds shall be formulated by the administrative department of medical security under the State Council in accordance with the law, the Regulations on The Administration of Medical Security also propose that medical security agencies should establish a collective bargaining and consultation mechanism with designated pharmaceutical institutions, reasonably determine the budget amount and time limit for the allocation of medical security funds for designated pharmaceutical institutions, and negotiate service agreements with fixed-point pharmaceutical institutions in accordance with the need to safeguard public health needs and management services.
in the industry's view, this move or to solve the problem of pharmaceutical institutions on the allocation of health care funds arrears.
, of course, the Regulations also set out new compliance requirements for the business practices of targeted pharmaceutical institutions.
If a fixed-point pharmaceutical institution violates the service agreement, the medical security agency may urge it to fulfill the service agreement, suspend or not allocate the payment fee in accordance with the service agreement, recover the non-compliance expenses, suspend the medical services used by the relevant responsible personnel or their departments involved in the medical security fund until the service agreement is lifted, and the fixed-point medical institutions and their related responsible personnel shall have the right to make statements and defend them.
Against the background of clear consequences of fraud and severe punishment for illegal acts in the context of the continued high-pressure anti-corruption efforts in the field of medicine, the Regulations also emphasize once again that in the course of the use of medical security funds, administrative departments such as medical security, medical security agencies, designated medical institutions and their staffs may not accept bribes or obtain other illegal income.
designated pharmaceutical institutions shall not facilitate the transfer of medicines by insured persons to take advantage of their medical security treatment to accept cash returns, in kind or other illegal benefits.
to the industry's high-profile "fraud and insurance" behavior, the Regulations also clearly define the consequences of violations, improve the illegal costs of pharmaceutical institutions and insured persons.
In accordance with the requirements of the Regulations on Administration, if a designated pharmaceutical institution defrauds the expenditure of the medical security fund by "inducing or assisting others to seek medical treatment under false pretentances, purchasing drugs, providing false supporting materials, or colluding with others to falsely open expense documents", the administrative department for medical security shall order the return, To obtain a fine of between 2 and 5 times the amount of fraud, to order the designated pharmaceutical institutions to suspend the medical services used by the relevant responsible departments for more than 6 months and not more than 1 year, until the service agreement is dissolved by the medical security agency, and if the competent departments are qualified to practise, the relevant competent departments shall revoke their qualifications in accordance with the law.
And if an individual exists in one of the circumstances, such as "handing over his medical security certificate to another person for use under an imposatory name and repeatedly enjoying medical security treatment", he shall be ordered by the administrative department of medical security to correct it;
individuals who, for the purpose of defrauding the medical security fund, have committed one of the acts specified in the previous paragraph, resulting in the loss of the medical security fund; Whoever destroys medical documents, medical certificates, accounting vouchers, electronic information and other relevant materials, or fictitious medical service items, etc., and defrauds the expenditure of the medical security fund shall, in addition to handling it in accordance with the provisions of the previous paragraph, also be fined by the administrative department of medical security for defrauding the amount of 2 times or less than 5 times.
generally believed that medical security is not only a major institutional arrangement concerning the needs of people's livelihood protection, but also a multi-level system with complex relationships that is clearly different from other safeguard systems.
stage, the contradiction of unbalanced and inadequate medical security in our country still exists, and it is very important to perfect the supervision system of medical insurance fund.
Some people in the industry pointed out that, as the first regulation in the field of medical security in China, the Regulations will change the situation of China's medical security system in the past long-term policy governance, in the path of legalization of medical insurance has a milestone significance, will help to further enhance the level of china's medical insurance governance.
The State Health Insurance Administration also revealed in its public reply letter that, in addition to pushing for the introduction of the Regulations, it is also studying the drafting of draft regulations on departments involving fund supervision, the management of fixed-point pharmaceutical institutions, the administration of basic medical insurance and other contents, and recommended to the National People's Congress Social Construction Committee that the Medical Security Law be included in the 2021 legislative plan of the National People's Congress, and that the basic work of various legislations should be solidly promoted.
The next step will be to follow the Opinions of the State Council of the CPC Central Committee on Deepening the Reform of the Medical Security System, comprehensively summarize the practice of medical security reform and local legislative experience, absorb the useful experience of extraterritive medical security legislation, actively promote legislative work, and effectively respond to the expectations of all sectors of society for the construction of the rule of law in medical security.
Chapter I General Provisions of the Regulations on the Use of Medical Security Funds Article 1 These Regulations are formulated in accordance with the Social Insurance Law of the People's Republic of China and other relevant legal provisions in order to strengthen the supervision and management of the use of medical security funds, safeguard the safety of the funds, promote the effective use of the funds and safeguard the legitimate rights and interests of citizens in medical security.
2 These Regulations shall apply to the use and supervision and management of medical security funds such as the Basic Medical Insurance (including Maternity Insurance) Fund and the Medical Assistance Fund within the territory of the People's Republic of China.
3 The use of the Medical Security Fund shall be guided by the people's health, the level of protection shall be in line with the level of economic and social development, and the principles of legality, safety, openness and people's safety shall be followed.
Article 4 The use of medical security funds for supervision and management is combined with government supervision, social supervision, industry self-discipline and personal trustworthy.
article 5 The people's governments at or above the county level shall strengthen their leadership over the supervision and management of the use of medical security funds, establish and improve the mechanism for the use of medical security funds and the system for the supervision and administration of funds, strengthen the capacity-building of the use of medical security funds for supervision and management, and provide guarantees for the use of medical security funds for supervision and management.
Article 6 The administrative department of medical security under the State Council shall be in charge of the supervision and management of the use of the national medical security fund.
other relevant departments of the State Council shall be responsible for the supervision and management of the use of the relevant medical security funds within their respective areas of responsibility.
administrative department of medical security of the local people's government at or above the county level shall be responsible for the supervision and management of the use of the medical security fund in the administrative area.
departments of the local people's governments at or above the county level shall be responsible for the supervision and management of the use of the relevant medical security funds within their respective areas of responsibility.
Article 7 The State encourages and supports the news media to carry out public welfare publicity on medical security laws, regulations and knowledge of medical security, and to supervise the use of medical security funds by public opinion.
publicity reports on medical security should be true and fair.
the people's governments at or above the county level and their administrative departments, such as medical security, shall, through written consultations and symposiums, listen to the opinions of deputies to the National People's Congress, members of the CPPCC and representatives of insured persons on the use of the medical security fund, open channels of social supervision, and encourage and support all sectors of society to participate in the supervision of the use of the medical security fund.
Medical institutions, pharmaceutical business units (collectively called pharmaceutical institutions) and other units and medical and health industry associations shall strengthen self-discipline in the industry, standardize the conduct of pharmaceutical services, promote industry norms and self-restraint, and guide the rational use of medical security funds in accordance with the law.
, the use of The use of the Medical Security Fund shall be in accordance with the scope of payment prescribed by the State.
scope of payment for medical security funds shall be formulated by the administrative department of medical security under the State Council in accordance with the law.
people's governments of provinces, autonomous regions and municipalities directly under the Central Government shall, in accordance with the authority and procedures prescribed by the State, supplement and formulate specific items and standards for the payment of medical security funds within their administrative areas and report them to the administrative department of medical security under the State Council for the record.
Article 9 The State shall establish and improve a unified national management system for the operation of medical security, provide standardized and standardized medical security management services, and achieve full coverage of provinces, cities, counties, townships (streets) and villages (communities).
Article 10 Medical security agencies shall establish and improve the operational, financial, security and risk management systems, do a good job in the management of service agreements, cost monitoring, fund allocation, treatment review and payment, and regularly disclose to the public the income, expenditure and balance of medical security funds and accept social supervision.
article 11 Medical security agencies shall establish a mechanism for collective bargaining and consultation with designated pharmaceutical institutions, reasonably determine the budget amount and time limit for the allocation of medical security funds for designated medical institutions, and negotiate and sign service agreements with designated pharmaceutical institutions in accordance with the need to safeguard public health needs and manage services, regulate the conduct of medical services, and clarify the violation of service agreements and their responsibilities.
medical security agencies shall promptly publish to the community the list of designated medical institutions that have signed service agreements.
departments of medical security shall strengthen supervision over the conclusion and performance of service agreements.
12 Medical security agencies shall settle and allocate medical security funds in a timely manner in accordance with the provisions of the service agreement.
designated medical institutions shall provide medical services in accordance with the provisions, improve the quality of service, make rational use of medical security funds, and safeguard the health rights and interests of citizens.
article 13 If a fixed-point medical institution violates the service agreement, the medical security agency may urge it to perform the service agreement, suspend or not allocate the payment fees in accordance with the service agreement, recover the illegal expenses, suspend the medical services of the relevant responsible personnel or their departments involved in the use of the medical security fund until the service agreement is lifted;
if a medical security agency violates a service agreement, the designated medical institution shall have the right to request correction or to submit it to the administrative department of medical security for coordination, to supervise and rectify the situation, or to apply for administrative reconsideration or initiate administrative proceedings in accordance with the law.
14 Fixed-point pharmaceutical institutions shall establish an internal management system for the use of medical security funds, with specialized agencies or personnel responsible for the management of the use of medical security funds, and establish and improve an assessment and evaluation system.
designated medical institutions shall organize and conduct training on the relevant systems and policies of the Medical Security Fund, regularly check the use of the medical security fund of their units, and promptly correct the irregular use of the Medical Security Fund.
Article 15 Fixed-point pharmaceutical institutions and their staff shall implement the regulations on the management of real-name medical treatment and purchase of medicines, verify the medical security certificates of the insured persons, provide reasonable and necessary medical services in accordance with the medical treatment norms, and truthfully issue expense documents and related information to the insured persons, and shall not decompose the hospitalization or hospitalization, nor shall they In violation of the norms of diagnosis and treatment, excessive diagnosis and treatment, over-examination, decomposition of prescriptions, over-prescribing, repeated prescription of drugs, shall not be repeated charges, over-standard charges, decomposition project charges, shall not be structured drugs, medical supplies, medical treatment projects and service facilities, may not induce, assist others to falsely seek medical treatment, purchase drugs.
The fixed-point medical institution shall ensure that the expenses paid by the medical security fund meet the prescribed scope of payment, and if medical services outside the scope of payment of the medical security fund are provided, except in exceptional circumstances such as emergency or rescue, the consent of the insured person or his next of kin or guardian shall be obtained.
article 16 Fixed-point medical institutions shall, in accordance with the provisions, keep financial accounts, accounting vouchers, prescriptions, medical records, medical examination records, details of expenses, records of access to medicines and medical supplies, etc., transmit the relevant data on the use of the Medical Security Fund in a comprehensive and accurate manner through the medical security information system, report to the medical security administrative department the information necessary for the supervision and management of the use of the medical security fund, disclose to the public information on medical expenses, cost structure and so on, and accept social supervision.
Article 17 The insured person shall seek medical treatment, purchase medicine and take the initiative to present it for examination with his medical security certificate.
shall have the right to request the fixed-point medical institutions to truthfully issue expense documents and related information.
shall properly keep their medical security vouchers to prevent others from using them under the pretation.
if, for special reasons, he needs to entrust another person to purchase the medicine on his behalf, he shall provide the identification of the principal and the trustee.
shall enjoy medical security treatment in accordance with the provisions and shall not be repeated.
shall have the right to request medical security consulting services from medical security agencies and make suggestions for improvement in the use of medical security funds.
Article 18 In the course of the use of medical security funds, administrative departments such as medical security, medical security agencies, designated medical institutions and their staff may not accept bribes or obtain other illegal income.
Article 19 Insured persons shall not take advantage of the opportunity to enjoy medical security treatment to resold medicines and accept the return of cash, in kind or other illegal benefits.
designated pharmaceutical institutions shall not facilitate the transfer of medicines by insured persons to take advantage of their medical security treatment to accept cash returns, in kind or other illegal benefits. article
Medical security agencies, designated medical institutions and other units and their staff and insured personnel shall not, through forgery, alteration, concealment, alteration, destruction of medical documents, medical certificates, accounting vouchers, electronic information and other relevant information, or fictitious medical services