I. Duties of the Jincheng City Medical Insurance Fund Monitoring and Anti-Fraud Center
The Jincheng City Medical Insurance Fund Monitoring and Anti-Fraud Center is responsible for monitoring the use of the citywide medical insurance fund, and discovering and warning of abnormal use in a timely manner by means of data analysis and risk assessment. At the same time, the center is also responsible for investigating and dealing with fraudulent acts involving the medical insurance fund, including fictitious medical services, fraudulent use of medical insurance funds and other illegal acts. By strengthening monitoring and combating fraud, the center aims to protect the security of the health insurance fund, ensure that every penny is put to good use, and provide better health insurance services for the insured.
The working mechanism of Jincheng City Medical Insurance Fund Monitoring and Anti-Fraud Center
In order to effectively perform its duties, the Jincheng City Medical Insurance Fund Monitoring and Anti-Fraud Center has established a perfect working mechanism. The center works closely with medical institutions and social security departments at all levels to ****share information resources and achieve data interoperability. At the same time, the center has set up a professional monitoring team, using advanced technical means to carry out real-time monitoring and analysis of the use of the health insurance fund. When anomalies are detected, the center will promptly initiate the investigation process to find out the truth and deal with them in accordance with the law.
Three, the effectiveness and significance of the Jincheng City Medical Insurance Fund Monitoring and Anti-Fraud Center
Through the work of the Jincheng City Medical Insurance Fund Monitoring and Anti-Fraud Center, effectively curbing the occurrence of fraudulent acts of medical insurance and protect the safety of the medical insurance fund. At the same time, the center's work has provided insured people with fairer and more transparent medical insurance services, and enhanced the people's trust in and support for the medical insurance system. In addition, the center's work helps promote the healthy development of the medical industry and the rational allocation and effective use of medical resources.
In summary:
The Jincheng City Medical Insurance Fund Monitoring and Anti-Fraud Center plays an important role in monitoring and preventing fraud in the city's medical insurance fund. By strengthening monitoring and combating fraud, the center protects the safety of the medical insurance fund, safeguards the legitimate rights and interests of the insured, and promotes the healthy development of the medical industry.
Legal basis:
The Social Insurance Law of the People's Republic of China*** and the State of China
Article 87 stipulates:
Where the social insurance administration organization as well as the social insurance service organizations such as the medical institutions and the drug business units cheat the social insurance fund expenditure by fraud, falsification of certificates, or other means, the administrative department of the social insurance shall order to return the cheated The social insurance premiums, the fraudulent amount of two times or more than five times the fine; belonging to the social insurance service institutions, the termination of the service agreement; directly responsible for the supervisors and other directly responsible personnel have practicing qualifications, shall be revoked in accordance with the law.
The Criminal Law of the People's Republic of China
Article 266 stipulates:
Fraud of public or private property, the amount of which is relatively large, shall be sentenced to fixed-term imprisonment of not more than three years, criminal detention, or control, and a fine or a single fine; the amount of which is huge or there are other serious circumstances, shall be sentenced to fixed-term imprisonment of not less than three years and not more than ten years, and shall be punished by a fine; the amount of which is particularly huge or there are other particularly serious circumstances, shall be sentenced to fixed-term imprisonment of not less than ten years and a fine; the amount of which is particularly huge or there are other particularly or other particularly serious circumstances, shall be sentenced to fixed-term imprisonment of not less than ten years or life imprisonment, and shall be fined or have property confiscated. Where this Law provides otherwise, it shall be in accordance with the provisions.