interim measures for handling reports on the supervision and management of the use of medical insurance funds article 1 these measures are formulated in accordance with the social insurance law of the people's Republic of China, the regulations on the supervision and management of the use of medical insurance funds and other relevant laws and administrative regulations in order to standardize the handling of reports on the supervision and management of the use of medical insurance funds, ensure timely and effective handling of reports, effectively safeguard the safety of medical insurance funds and protect the legitimate rights and interests of natural persons, legal persons or other organizations.
article 2 these measures shall apply to the handling of reports of illegal use of basic medical insurance (including maternity insurance) funds, medical assistance funds and other medical insurance funds.
the term "reporting" as mentioned in these measures means that a natural person, a legal person or any other organization (hereinafter referred to as a reporter) reports to the administrative department of medical security that the reported person is suspected of violating the laws, regulations and rules on the supervision and administration of the use of medical security funds.
Article 3 The administrative department of medical security in the State Council shall be in charge of the handling of reports nationwide and guide the handling of reports by local administrative departments of medical security. Medical security administrative departments at all levels shall establish and improve the reporting and handling mechanism.
the administrative department of medical security at or above the county level is responsible for handling reports within its administrative area. Where laws, administrative regulations and departmental rules provide otherwise, such provisions shall prevail.
Article 4 When handling reports, the administrative department of medical security shall follow the principles of unified leadership, territorial management, responsibility at different levels, fairness and efficiency, and ensure correct application basis and legal procedures.
article 5 encourages the public and the news media to conduct social supervision and public opinion supervision on illegal acts suspected of violating the supervision and management of the use of medical insurance funds according to law.
article 6 a report to the administrative department of medical security shall be made through the internet, telephone, fax, mailing address and other channels announced by the administrative department of medical security. The clues received by the medical security agencies and other departments shall be handled by the administrative department of medical security according to law and handed over to the administrative department of medical security for handling.
medical security administrative departments at all levels should smooth the reporting channels and strengthen the specialization and integration of reporting channels.
article 7 an informer shall provide specific clues about the alleged violation of laws, regulations and rules on the supervision and administration of the use of medical insurance funds. Informants who report in a non-written way shall be recorded by the staff of the administrative department of medical security.
Article 8 A whistleblower may report under his real name or anonymously. If the informant reports with his real name, he should provide his real identity information and real and effective contact information when reporting. Informants are encouraged to report their real names, and the administrative department of medical security shall, in accordance with the requirements of these measures, perform relevant notification procedures and keep the information of real-name informants strictly confidential.
the administrative department of medical security shall register the reports received.
Article 9 A report shall be handled by the administrative department of medical security at or above the county level where the reported behavior occurred. Where laws, administrative regulations and departmental rules provide otherwise, such provisions shall prevail.
if the medical security administrative department that receives the report does not have the handling authority, it shall inform the informant to directly submit it to the medical security administrative department that has the handling authority.
the report that the lower medical security administrative department thinks needs to be handled by the higher medical security administrative department can be reported to the higher medical security administrative department for decision; The administrative department of medical security at a higher level may handle the report received by the administrative department of medical security at a lower level if it deems it necessary.
article 1 if there is a dispute between two or more medical security administrative departments due to their handling authority, it shall be settled through consultation within 7 working days from the date of the dispute; If negotiation fails, it shall be reported to the administrative department of medical security at the next higher level at the same level as * * * to designate the handling department.
article 11 the working organization that the medical security administrative department at or above the county level uniformly receives the report shall promptly distribute the report to the lower medical security administrative department with the handling authority or the relevant institutions of the medical security administrative department at the same level for handling.
the relevant institutions of the administrative department of medical security at the same level shall, after receiving the reports distributed, deal with them in a timely manner in accordance with the relevant provisions of these measures. Do not have the authority to deal with, it should be timely feedback to the unified working mechanism to receive reports, and shall not be transferred by itself.
Article 12 The administrative department of medical security shall handle the report in accordance with the relevant provisions such as administrative punishment of medical security.
if the informant reports under his real name, the administrative department of medical security with handling authority shall inform the informant within 5 working days from the date of making a decision on whether to file a case.
article 13 if the laws, regulations and rules stipulate that the administrative department of medical security shall inform the informant of the handling result of the report, the administrative department of medical security shall inform him.
Article 14 Before the medical security administrative department makes a decision on handling the reported matters, if the informant voluntarily withdraws the report, it will not affect the investigation and handling by the medical security administrative department; The administrative department of medical security will no longer inform the reporter of the results.
Article 15 The reported person shall cooperate with the investigation by the administrative department of medical security according to law.
Article 16 The administrative department of medical security shall keep confidential the information of the informer, and shall not disclose the personal information of the informer and the handling of the report to the informer or any person irrelevant to the handling of the report.
the administrative department of medical security shall strictly keep confidential the state secrets obtained in the report handling and the information that may endanger national security, public security, economic security and social stability after disclosure.
information involving trade secrets, personal privacy, etc. shall be implemented in accordance with the Regulations of the People's Republic of China on Information Disclosure and other relevant regulations.
Article 17 The administrative department of medical security shall strengthen the statistics, analysis and application of reporting information in its own administrative area, and regularly publish reporting statistical analysis reports.
Article 18 A whistleblower shall be responsible for the authenticity of the contents of the report and the materials provided. Whoever fabricates or distorts facts and falsely accuses or frames others shall bear relevant legal responsibilities according to law.
Article 19 The administrative department of medical security in the State Council shall establish an annual reporting system for reporting and handling, and the provincial administrative departments of medical security shall report the reporting and handling of the previous year to the administrative department of medical security in the State Council before April 3th each year. In case of major issues, the provincial administrative departments of medical security shall report to the administrative departments of medical security in the State Council in a timely manner according to the regulations.
Article 2 The administrative department of medical security shall publicize the typical cases that have been verified and have great social impact; But those involving state secrets, work secrets, business secrets and personal privacy shall be implemented in accordance with the Regulations of the People's Republic of China on Information Disclosure and other relevant regulations.
article 21 the administrative department of medical security shall reward a report that is verified to meet the reward conditions.
article 22 the administrative department of medical security shall, within 5 working days after the completion of the report, file the relevant information involved in the report handling process according to the relevant archives management regulations, and keep the file for future reference.
Article 23 Medical security administrative departments at all levels shall be equipped with professionals, provide necessary office space and office equipment, and ensure the smooth reception and handling of reports.
twenty-fourth illegal use of residents' serious illness insurance, large medical expenses subsidies for employees, civil servants' Medicaid and other medical security funds shall be handled with reference to these measures.
article 25 these measures are not applicable to consultation, application for government information disclosure, application for administrative reconsideration, letters and visits in the form of reports, and the administrative department of medical security may inform them to submit them through corresponding channels.
article 26 these measures shall come into force as of March 1, 222.