The basic medical security system as mentioned in these Measures includes the basic medical insurance system for urban workers (including medical insurance for migrant workers), the basic medical insurance system for urban residents, the new rural cooperative medical system and the medical difficulties relief system. Article 3 The municipal administrative department of labor security shall be responsible for the management of basic medical security in this Municipality. The administrative department of labor security of each district and county (city) shall be responsible for the management of basic medical security in this overall planning area. Medical insurance agencies at all levels shall be specifically responsible for the daily management of basic medical security in this overall planning area.
Health, civil affairs, finance, taxation, price, food and drug supervision, education, industry and commerce, auditing, public security and other administrative departments shall, according to their respective responsibilities, coordinate the implementation of these measures.
The administrative department of labor and social security may entrust the regional medical insurance agencies to supervise and inspect the charging standards, drug prices and basic medical security services of designated medical institutions and retail pharmacies, and investigate and deal with violations of the provisions of the basic medical security system according to law. Article 4 Where an entity participating in basic medical insurance (hereinafter referred to as the employing unit) forges certificates, provides false certificates or falsely reports or restates medical expenses, the medical insurance agency shall recover the basic medical insurance fund for illegal expenditures, and the administrative department of labor security shall impose a fine of 5,000 yuan to 20,000 yuan on the employing unit, and impose a fine of 500 yuan to 2,000 yuan on the directly responsible person in charge and other responsible persons respectively. Article 5 If the insured person of basic medical insurance (hereinafter referred to as the insured person) and other personnel commit any of the following acts, the medical insurance agency shall recover the basic medical insurance fund for illegal expenditures, and the administrative department of labor security shall impose a fine of more than 2,000 yuan from 500 yuan:
(1) Lending my basic medical insurance certificate (card) to others for use, or transferring my basic medical insurance benefits to others for enjoyment;
(two) forged or fraudulent use of other people's basic medical insurance card (card) for medical treatment;
(3) Allocating drugs and medical devices that are inconsistent with my illness and the provisions of the basic medical security system, or over-allocating drugs and medical devices, or defrauding medical services that are inconsistent with my illness and the provisions of the basic medical security system through repeated visits, or forging, altering or destroying medical documents;
(four) sales of drugs and medical devices in the basic medical security drug list, or sales of medical materials and services in the basic medical security services;
(five) refusing to cooperate with the supervision and inspection of the administrative department of labor security and the medical insurance agency, refusing to provide or intentionally damaging medical documents and other materials in the process of supervision and inspection;
(six) other acts in violation of the provisions of the basic medical security system. Article 6 If a designated medical institution and its staff commit any of the following acts, the medical expenses applied for in the current month shall be deducted according to the proportion of the illegal expenses in the medical expenses of the medical insurance agency, in addition to the basic medical insurance fund recovered by the medical insurance agency. If the circumstances are serious, the administrative department of labor security shall impose a fine of more than 2,000 yuan from 500 yuan on its legal representative and the person directly responsible. If the circumstances are particularly serious, the administrative department of labor security will also cancel its qualification as a designated medical institution:
(a) the basic medical insurance certificate (card) was not checked when the diagnosis and treatment were kept;
(two) the medical expenses of non-insured persons or the expenses not paid by the basic medical insurance fund are included in the payment scope of the basic medical insurance fund;
(three) allowing or conniving at false medical treatment or false hospitalization;
(four) the insured who does not meet the hospitalization conditions is admitted to the hospital, or the insured who meets the discharge conditions should be discharged and continue to be hospitalized;
(5) When receiving medical treatment, the insured's previous medical records were not reviewed, or repeated medication, non-medical examination and treatment, or repeated examination and treatment;
(6) No medical records were recorded at the time of admission, or the medical records were unclear and incomplete, which was inconsistent with the prescription or the medical expenses incurred, or the medical expenses incurred were inconsistent with the condition;
(seven) the loss of the basic medical insurance fund caused by price violations;
(eight) do not prescribe according to the provisions of prescription management, or use drugs and medical devices in excess of the dose;
(9) Providing counterfeit and inferior drugs, medical devices or medical materials to patients;
(ten) refused to cooperate with the supervision and inspection of the administrative department of labor security and medical insurance agencies, refused to provide or deliberately damaged medical documents and other information in the process of supervision and inspection;
(eleven) other acts in violation of the provisions of the basic medical security system.
Designated medical institutions and their staff take cash, or include the expenses of non-basic medical security funds such as daily necessities and health supplements into the payment scope of basic medical security funds, or defraud the basic medical security funds by forging or altering medical documents, bills and statements. The administrative department of labor and social security shall cancel its qualification as a designated medical institution.