Medical insurance agencies are responsible for the daily management of basic medical insurance services in accordance with laws, regulations and state provisions, and are entrusted with the supervision and management of basic medical insurance services.
Other relevant departments of the people's governments at or above the county level are responsible for the supervision and management of basic medical insurance services and related activities in accordance with their prescribed duties. Article 6 medical institutions shall establish and improve the basic medical insurance service management system, to determine the organization or personnel responsible for the daily management of the basic medical insurance services, and strengthen the relevant departments and their staff of the basic medical insurance service knowledge training, and constantly improve the level of service.
The relevant departments of medical institutions and their staff shall, in accordance with the provisions of the state, the province and the relevant basic medical insurance drug list, diagnostic and treatment items, standards of medical services and facilities, as well as the basic medical insurance service agreement, to provide timely, reasonable and necessary medical services for the insured. Article 7 Retail pharmacies shall establish and improve the management system of basic medical insurance services, determine the personnel responsible for the daily management of the basic medical insurance services of the organization, strengthen the training of basic medical insurance service knowledge for the sales staff, and engage in the sale of medicines and other activities in accordance with the relevant provisions of the country, the province and the coordinating area as well as the agreement on basic medical insurance services. Article 8 Medical institutions, retail pharmacies and their staff, in the course of providing basic medical insurance services, shall not engage in the following behaviors that defraud the basic medical insurance fund of its expenses or cause losses to the fund:
(1) Allowing a non-participant to use the name of a participant under false pretenses, or a participant to use the name of another person to seek medical treatment;
(2) Allowing the use of the basic medical insurance fund to pay for medical expenses of a non-participant or a participant under false pretenses; and (b) Allowing the use of the basic medical insurance fund to pay for the medical expenses of non-participants or the medical expenses that participants should pay out of their own pockets according to the regulations;
(c) using forged or altered diagnostic certificates, medical records, prescriptions and other supporting materials, or false medical bills or charge details to fraudulently obtain the expenditure of the basic medical insurance fund;
(d) applying for false hospitalization or falsely recording the medical expenses;
(e) not in accordance with the needs of the condition of the diagnosis and treatment. (v) Abusing large equipment for examination, expensive drugs for treatment, or providing other unnecessary medical services to the insured;
(vi) Allowing the use of basic medical insurance vouchers to obtain cash, securities, or to purchase daily necessities, food, and other non-medical supplies;
(vii) Lending or transferring the information settlement terminal equipment of the basic medical insurance expenses to other units or individuals for their use;< /p>
(viii) violating the price management regulations to collect medical expenses that need to be paid by the basic medical insurance fund;
(ix) other fraudulent acts of the basic medical insurance fund expenditures or cause losses to the fund. Article 9 The insured units shall strengthen the internal management and service of the insured persons in their units, and provide the relevant supporting materials of the insured persons to the medical insurance administration organizations in a timely and accurate manner.
After the dissolution or termination of the labor relationship (personnel relationship) between the insured and the insured unit, the insured unit shall promptly submit the relevant procedures to the medical insurance agency. Article 10 Participants shall comply with the following provisions:
(1) When seeking medical treatment or purchasing medicines, they shall take the initiative to present their basic medical insurance vouchers, accept the verification of documents by medical institutions and retail pharmacies, and consciously fulfill their obligations of good faith;
(2) they shall not fraudulently use other people's basic medical insurance vouchers to seek medical treatment, or forged or altered diagnostic certificates, medical records, prescriptions, and other documents, or fraudulently obtain medical bills, charge details, or other means to cheat the medical institutions.