Interim Measures for Supervision and Administration of Medical Insurance Fund Use Report Processing
Article 1 To standardize the use of medical insurance fund supervision and management of report processing to ensure timely and effective handling of the report, and effectively safeguard the safety of medical insurance fund, to protect the lawful rights and interests of natural persons, legal persons or other organizations, in accordance with the "Chinese People's Republic of China *** and the State Social Insurance Law," "supervision and management of the use of medical insurance fund Management Regulations" and other relevant laws and administrative regulations, the formulation of these measures.
Article 2: These Measures shall apply to the handling of reports of illegal use of the basic medical insurance (including maternity insurance) fund, medical aid fund and other medical insurance funds.
The measures referred to in the report, refers to natural persons, legal persons or other organizations (hereinafter referred to as the whistleblower) to the medical insurance administrative department to reflect the reported person suspected of violating the supervision and management of the use of medical insurance fund laws, rules and regulations.
Article 3 of the State Council administrative department of medical insurance in charge of the national report processing work, to guide the local administrative department of medical insurance report processing work. Medical insurance administrative departments at all levels to establish and improve the report processing mechanism.
Medical security administrative departments at or above the county level is responsible for the administrative region of the report processing work. Laws, administrative regulations, departmental rules provide otherwise, in accordance with its provisions.
Article IV of the medical insurance administrative departments to deal with the report, should follow the unified leadership, local management, hierarchical responsibility, fair and efficient principle, so that the application of the correct basis, the procedure is legal.
Article V encourages the public and the news media suspected of violating the supervision and management of the use of medical insurance fund violations of the law to carry out social supervision and public opinion supervision.
Article VI to the medical insurance administrative department to report, should be announced through the medical insurance administrative department to receive reports on the Internet, telephone, fax, mailing address and other channels. Medical insurance agencies and other departments to receive reports, according to law should be dealt with by the administrative department of medical insurance, transferred to the administrative department of medical insurance to deal with.
Medical security administrative departments at all levels should open up reporting channels, strengthen the reporting channel specialization and integration.
Article VII of the whistleblower shall be suspected of violating the supervision and management of the use of medical insurance fund laws, rules and regulations of the specific clues. Whistleblowers take a non-written report, the administrative department of medical insurance staff shall record.
Article VIII of the whistleblower can be reported in name or anonymous report. Whistleblowers report in name, the report should provide their real identity information and real and effective contact information. Encourage whistleblowers to report in real name, the administrative department of medical insurance requirements, fulfill the relevant procedures to inform the real name of the whistleblower's information to be strictly confidential.
Medical security administrative departments to receive reports are registered.
Article IX of the report by the reported behavior of the county level or above, the administrative department of medical insurance. Laws, administrative regulations, departmental rules provide otherwise, in accordance with its provisions.
Report received by the administrative department of medical insurance does not have the authority to deal with, shall inform the informant directly to the administrative department of medical insurance and other processing authority.
Lower medical insurance administrative departments that need to be handled by the higher administrative departments of health care, can be reported to the higher administrative departments of health care decision; higher administrative departments of health care that it is necessary to deal with the lower administrative departments of health care to receive the report.
Article X of the two or more administrative departments of medical insurance dispute over the authority to deal with the dispute shall be resolved through consultation within seven working days from the date of the dispute; if the consultation fails, the report **** the same higher level of the administrative department of medical insurance to designate the handling of the department.
Article XI of the county above the administrative department of medical insurance to receive reports of the work of the unified agency, shall promptly send the report has the authority to deal with the lower level of the administrative department of medical insurance or the same level of the administrative department of medical insurance agencies to deal with the relevant institutions.
The same level of medical insurance administrative department of the relevant agencies received the report sent, should be dealt with in accordance with the relevant provisions of this approach in a timely manner. Do not have the authority to deal with, it should be promptly returned to the unified receiving agency, shall not be transferred on its own.
Article XII of the administrative department of medical insurance shall be in accordance with the relevant provisions of the administrative penalty of medical insurance to deal with the report.
The informant's name, have the authority to deal with the administrative department of medical insurance shall make a decision on whether or not to file a case within five working days from the date of informing the informant.
Article XIII of laws, regulations, rules and administrative departments of medical insurance shall inform the whistleblower of the results of the report, the administrative department of medical insurance shall be informed.
Article XIV of the reported matters have been filed, the administrative department of medical insurance to make a decision before the whistleblower took the initiative to withdraw the report, does not affect the investigation and handling of the administrative department of medical insurance; medical insurance administrative department will no longer inform the whistleblower of the results of the investigation.
Article XV of the whistleblower shall cooperate with the administrative department of medical insurance investigation.
Article XVI of the administrative department of medical insurance shall keep the informant's information confidential, shall not disclose the informant's personal information, report the handling of the situation to the informant or persons unrelated to the handling of the report.
The handling of reports learned in the work of state secrets and public information may jeopardize national security, public **** security, economic security, social stability, the administrative department of medical insurance shall be strictly confidential.
Involving commercial secrets, personal privacy and other information, in accordance with the "Chinese People's **** and State Government Information Disclosure Regulations" and other relevant provisions.
Article XVII of the medical insurance administrative department shall strengthen the administrative region of the report information statistics, analysis, application, regularly published report statistical analysis.
Article XVIII of the whistleblower shall be responsible for the content of the report and the authenticity of the materials provided. Fabrication, distortion of facts, false accusations against others, shall bear the relevant legal responsibility.
Article XIX of the State Council administrative department of medical insurance to establish the annual report processing system, the provincial administrative departments of medical insurance should be April 30 each year, to the State Council administrative department of medical insurance report on the previous year's report processing work. In the event of major issues, the provincial medical insurance administrative department shall promptly report to the State Council in accordance with the provisions of the administrative department of medical insurance.
Article 20 of the medical insurance administrative department of the investigated and has a significant social impact of the typical case, should be announced to the community; but involves state secrets, work secrets, commercial secrets and personal privacy, in accordance with the "Chinese People's *** and the State Government Information Disclosure Regulations" and other relevant provisions.
Article 21 is verified to meet the conditions of reporting incentives reported, the medical insurance administrative department shall be rewarded in accordance with the provisions.
Second Article 22 of the administrative department of medical insurance shall be completed within five working days, according to the relevant provisions of the file management, the processing of the report involves the relevant information on file, keep the file for inspection.
Article 23 of the administrative department of medical insurance at all levels should be equipped with professional staff, provide the necessary office space, office equipment, etc., to ensure that the receipt of reports, processing work smoothly.
Article 24 of the illegal use of residents' major medical insurance, employee subsidies for large medical expenses, civil service medical subsidies and other medical insurance funds, with reference to the implementation of these measures.
Article 25 of the report in the form of counseling, government information disclosure applications, applications for administrative reconsideration, petitions and other activities, does not apply to the present measures, the administrative department of medical insurance can tell through the appropriate channels.
Article 26 These Measures shall come into force from March 1, 2022 onwards.