Medical institutions cheat insurance behavior are:
1, designated medical institutions and their staff cheat insurance; Fictitious medical services, forged medical documents and bills, and defrauded medical insurance funds;
2, designated retail pharmacies and their staff fraud;
3. The fraudulent insurance behavior of the insured;
4, medical insurance agency staff resort to deceit.
Designated medical institutions applying for medical insurance shall meet the following requirements:
1, with a medical institution practice license and registered according to law;
2, have the corresponding medical service ability, including medical equipment, medical personnel and medical quality control conditions;
3. It has a good reputation and reputation, and there are no major medical accidents or medical disputes;
4, accept the supervision and management of medical insurance management department, in accordance with the provisions of the implementation of medical insurance policies and fees;
5, signed an agreement with the medical insurance management department, clear medical service content, charging standards, quality control and other aspects;
6. Have a good service attitude and quality, and be able to provide high-quality and efficient medical services for the insured;
7. To apply for designated medical insurance, it is necessary to submit relevant application materials to the local medical insurance management department, including medical institution's practice license, medical service ability evaluation report, medical quality control documents, medical insurance charging standards and other related materials.
The medical insurance management department will review the application materials, and qualified medical institutions will be included in the list of local medical insurance designated institutions, becoming one of the insured's medical choices.
To sum up, different regions may have different application requirements for designated medical insurance, and specific requirements need to refer to relevant local policies and regulations.
Legal basis:
Article 31 of People's Republic of China (PRC) Social Insurance Law
According to the needs of management services, social insurance agencies can sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior.
Medical institutions shall provide reasonable and necessary medical services for the insured.
Article 87
Social insurance agencies, medical institutions, pharmaceutical trading units and other social insurance service institutions defraud social insurance fund expenditures by fraud, forgery of certification materials or other means, and the social insurance administrative department shall order them to return the defrauded social insurance money and impose a fine of more than 2 times and less than 5 times the amount defrauded; If it belongs to a social insurance service institution, the service agreement shall be terminated; If the directly responsible person in charge and other directly responsible personnel are qualified, their qualifications shall be revoked according to law.