The market supervision and management department of the people's government at or above the county level is responsible for price supervision and inspection of the medical and health industry. Market supervision and management department of the people's government at or above the county level, drug supervision and management departments in accordance with their duties to regulate drug business behavior.
The financial departments of the people's governments at or above the county level is responsible for regulating the medical insurance fund budget, financial account accounting, according to the law to investigate and deal with units and individuals in violation of the medical insurance fund financial accounting behavior.
The public security organs of the people's governments at or above the county level are responsible for investigating and dealing with all kinds of fraud and insurance fraud and other criminal acts according to law.
Other relevant departments of the people's governments at or above the county level in their respective areas of responsibility to do related work. Article VI of the provincial and municipal people's governments in the area of medical insurance administrative departments shall implement the basic health insurance outpatient **** relief mechanism, allowing family members **** relief. Article 7 encourages and supports citizens, legal persons and unincorporated organizations to carry out social supervision of the use of medical insurance fund.
The medical insurance administrative departments of the people's governments at or above the county level are responsible for establishing a system of social supervisors for the medical insurance fund, and hiring deputies to the National People's Congress, members of the Chinese People's Political Consultative Conference (CPPCC), representatives of insured persons, and practitioners in the news media to serve as social supervisors.
The people's governments at or above the county level, the medical insurance administrative department shall be published through the government website, new media to the community to report violations of the use of medical insurance fund complaints contact information. Article VIII of the provincial people's government administrative department of medical insurance according to the national development of the scope of payment, supplemented by the development of the province's medical insurance fund to pay for specific items and standards, approved by the provincial people's government, reported to the State Council administrative department of medical insurance for the record and then implemented. Article 9 The medical insurance agency shall establish a collective bargaining and negotiation mechanism with the designated medical institutions and drug business units (hereinafter collectively referred to as the designated medical institutions), and sign a service agreement in accordance with the law to regulate the rights and obligations of both parties, and to clarify the violation of the service agreement and its responsibility.
Medical security agencies, in accordance with laws and regulations and relevant provisions, to carry out cost reviews, audit checks and performance appraisals on the fulfillment of the service agreement by the designated medical institutions.
The medical insurance agency shall publicize the name and address of the designated medical institution that has signed the service agreement to the public through the government website, the government new media, and the notice board in the office hall. Article 10 The medical insurance agency shall, in accordance with the service agreement, within 30 working days from the date of the fixed-point medical institutions to declare the settlement, and disbursement of health insurance costs in accordance with the provisions. Article 11 The fixed-point medical institutions shall comply with the province's basic medical insurance drug directory, diagnostic and treatment items, medical service facility standards, medical consumables directory and its payment standards and price management regulations.
Pointed medical institutions should be in a prominent position in the unit or website, etc. to the community to disclose the price of medicine, medicine, cost, cost structure and other information, and accept social supervision. Article XII of the fixed-point medical institutions shall establish the use of medical insurance fund internal management system, set up a medical insurance management organization or professional medical insurance management commissioner, according to the basic medical insurance network settlement and intelligent monitoring requirements, equipped with networking equipment to upload real-time information related to health insurance, establish and improve the relevant medical insurance management and evaluation system. Article 13 Public medical institutions shall implement the system of centralized purchasing and use of medicines with quantity, and purchase and use medicines and medical consumables through the centralized purchasing platform. Encourage other designated medical institutions to purchase and use drugs and medical consumables through the centralized purchasing platform.
Manufacturers of drugs and medical consumables subject to centralized banded purchasing shall report their production capacity, inventory and supply in accordance with the regulations, and shall not provide false materials. Supply enterprises shall supply drugs and medical consumables in accordance with the selected price within the declared supply capacity, and shall not refuse online procurement by designated medical institutions. Article 14 The medical insurance administrative department of the provincial people's government shall establish and improve the medical insurance information system, and carry out the supervision and management of the use of the medical insurance fund of the designated medical institutions in the whole process of prior reminder, monitoring, and auditing after the event. Article 15 The medical insurance administrative department of the people's government at or above the county level can hire accounting firms and other non-directly interested third-party organizations and professionals to assist in the inspection, audit or verification of the use of the basic medical insurance fund.