Medical institutions fraudulent insurance behavior are:
1, designated medical institutions and their staff fraudulent insurance behavior; fictitious medical services, forged medical documents and bills, fraudulent health insurance fund;
2, designated retail pharmacies and their staff fraudulent insurance behavior;
3, the fraudulent insurance behavior of the insured;
4, fraudulent insurance behavior of the staff of the medical insurance agency.
Application for medical insurance designated medical institutions need to meet the following requirements:
1, with a medical license, and registered in accordance with the law;
2, with the appropriate medical service capacity, including medical equipment, medical personnel and medical quality control and other aspects of the conditions;
3, with a good reputation and goodwill, has not been a major medical incident or medical disputes;
4, medical security agency staff fraudulent insurance fraud. Medical accidents or medical disputes;
4, accept the supervision and management of the medical insurance management department, in accordance with the provisions of the implementation of medical insurance policies and fees;
5, with the medical insurance management department signed an agreement specifying the content of medical services, fees, quality control, etc.;
6, with a good service attitude and quality of service, to provide quality and efficient medical services for the insured persons.
7, the application for health insurance designated need to submit relevant application materials to the local health insurance management department, including medical institutions, medical practice license, medical service capacity assessment report, medical quality control documents, health insurance fee schedule and other related materials.
The medical insurance management department will review the application materials, and the medical institutions that meet the requirements will be included in the local medical insurance designated institutions list, and become one of the medical choices for the insured.
In summary, the application requirements for medical insurance designation may vary from region to region, and the specific requirements should be referred to the relevant local policies and regulations.
Legal basis:
Article 31 of the Social Insurance Law of the People's Republic of China
Social insurance agencies may, according to the needs of management and service, enter into service agreements with medical institutions and pharmaceutical business units to regulate the behavior of medical services.
Medical institutions shall provide reasonable and necessary medical services to insured persons.
Article 87
Where a social insurance administration organization and a medical institution, a pharmaceutical business unit or other social insurance service institution defrauds the social insurance fund of expenditure by fraud, falsification of certifying documents or other means, the administrative department of social insurance shall order the return of the defrauded social insurance premiums, and impose a fine of not less than two and not more than five times the amount of the defrauded premiums; where it belongs to the social insurance service institution, the service agreement shall be terminated; the person directly responsible for it shall be dismissed. Service agreement; directly responsible for the supervisors and other directly responsible personnel have practicing qualifications, revoke their licenses according to law.