I. Responsibilities of Jincheng Medical Security Fund Monitoring and Anti-fraud Center
Jincheng Medical Security Fund Monitoring and Anti-fraud Center is responsible for monitoring the use of medical security funds within the city, and timely discovering and early warning abnormal use through data analysis, risk assessment and other means. At the same time, the center is also responsible for investigating fraudulent acts involving medical insurance funds, including fictitious medical services, defrauding medical insurance funds and other illegal acts. By strengthening monitoring and cracking down on fraud, the center aims to protect the safety of the medical insurance fund, ensure that every penny is used effectively, and provide better medical security services for the insured.
Second, the working mechanism of Jincheng Medical Security Fund Monitoring and Anti-fraud Center
In order to effectively perform its duties, Jincheng Medical Security 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 realize data interconnection. At the same time, the center has also established a professional monitoring team to monitor and analyze the use of medical insurance funds in real time by using advanced technical means. If an abnormal situation is found, the center will start the investigation procedure in time to find out the truth and deal with it according to the law.
Third, the effectiveness and significance of Jincheng Medical Security Fund Monitoring and Anti-fraud Center
Through the work of Jincheng Medical Insurance Fund Monitoring and Anti-fraud Center, the occurrence of medical insurance fraud has been effectively curbed, and the safety of medical insurance funds has been guaranteed. At the same time, the work of the center also provides more fair and transparent medical security services for the insured, and enhances the people's trust and support for the medical security system. In addition, the work of the center is also helpful to promote the healthy development of the medical industry and promote the rational allocation and effective utilization of medical resources.
To sum up:
Jincheng Medical Security Fund Monitoring and Anti-fraud Center plays an important role in the monitoring and anti-fraud work of the city's medical security fund. By strengthening monitoring and cracking down on fraud, the center has protected the safety of the medical insurance fund, safeguarded the legitimate rights and interests of the insured and promoted the healthy development of the medical industry.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 87 provides that:
Social insurance agencies, medical institutions, pharmaceutical trading units and other social insurance service institutions defraud social insurance fund expenditures by fraud, forgery of certification materials or other means, and the social insurance administrative department shall order them to return the defrauded social insurance money and impose a fine of more than 2 times and less than 5 times the amount defrauded; If it belongs to a social insurance service institution, the service agreement shall be terminated; If the directly responsible person in charge and other directly responsible personnel are qualified, their qualifications shall be revoked according to law.
Criminal law of the people's Republic of China
Article 266 stipulates that:
Whoever defrauds public or private property in a relatively large amount shall be sentenced to fixed-term imprisonment of not more than three years, criminal detention or public surveillance, and shall also, or shall only, be fined; If the amount is huge or there are other serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than three years but not more than ten years and shall also be fined; If the amount is especially huge or there are other especially serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 10 years or life imprisonment, and shall also be fined or confiscated. Where there are other provisions in this Law, such provisions shall prevail.