Legal analysis: The medical insurance unannounced inspection system refers to the medical insurance administrative department’s inspection of medical insurance agencies, medical bidding and procurement agencies, designated medical institutions, pharmaceutical companies, medical insurance doctors (pharmacists), insured persons, etc. Unannounced on-site surveillance inspections using the Medical Security Fund Act. This system has the following characteristics: First, it is legal and authoritative. It is usually established by the superior medical insurance administrative department in accordance with the Social Insurance Law, the "Administrative Enforcement Law", the "Regulations on the Functional Allocation, Internal Organizations and Staffing of the National Medical Security Administration" and the "Medical Security Fund". "Supervisory Flight Inspection Procedures (Trial)" authorizes administrative actions that are actively implemented without being requested to be initiated by the supervisory inspection unit; the second is directness, where the medical insurance administrative department directly conducts on-site inspections of people, objects, behaviors, places, etc.; thirdly, it is direct. The first is surprise, unannounced inspections are usually carried out in secret, that is, the medical insurance administrative department does not inform the inspected objects in advance; the fourth is mandatory, when the inspected objects forge, alter, transfer, conceal, alter and destroy financial accounts, accounting vouchers, The medical insurance administrative department has the right to take coercive measures when it comes to prescriptions, medical records, treatment and examination records, expense details, and records of the entry and exit of drugs and medical devices. When the subject being inspected fails to cooperate, refuses, or obstructs the medical insurance administrative department from carrying out inspections, the medical insurance administrative department may For compulsory inspections, the inspected objects will bear corresponding legal responsibilities; fifthly, objectivity, the medical insurance administrative department can invite the health, public security, and drug regulatory departments to jointly conduct unannounced inspections, and organize qualified social third parties to participate in the inspection by purchasing services , according to the needs of the inspection work, the news media can be invited to participate in the supervision; Sixth, the intrusiveness, unannounced inspection will bring adverse consequences to the inspected objects, that is, the inspected objects are set to accept on-site inspection, keep information, accept inquiries, etc. Restrict the relative rights and interests of places, personnel, materials, etc. for a certain period of time, and implement administrative actions such as administrative coercive measures.
Legal basis: "Social Insurance Law of the People's Republic of China"
Article 23 Employees shall participate in employee basic medical insurance, which shall be provided by the employer and employees in accordance with national regulations* **Same as paying basic medical insurance premiums.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay for the basic medical insurance in accordance with national regulations. fee.
Article 24 The state shall establish and improve a new rural cooperative medical system. The management measures for the new rural cooperative medical system shall be stipulated by the State Council.