Qinghai enacted a new policy to prevent fraud and protect the “life-saving money” of the masses.

Original Title: Qinghai Introduced New Policy to Prevent Fraud and Protect “Life-Saving Money” from the Masses

The Qinghai Provincial Health Insurance Bureau reported on 4 that in order to strongly promote the innovation of the health insurance governance system and the building of governance capacity, the Qinghai Provincial Health Insurance Bureau formulated and issued the “Provincial Health Insurance of QinghaibackgroundMeasures for the supervision of unannounced inspections (test) and issued jointly with the Department of Finance of Qinghai ProvincesocietyPower to buy health insuranceMonitoring of fundsServiceMeasures (for trial implementation) “to prevent fraudulent insurance and further strengthen the supervision of health insurance funds.

In 2019, the National Health Insurance Office reportedly scanned and instituted unannounced inspectionsjobsmechanismAnd gradually improve flight inspection.Work flowGood results have been achieved through unannounced inspections to supervise and guide local governments to supervise health insurance funds.

In recent years, the Qinghai Province Health Insurance Department has taken special measures to combat fraud and insurance, investigating and dealing with a lot of illegal and illegal use of health insurance funds.behaviorIt established a dissuasive regulatory situation, but the province’s funding regulatory situation remains dire, with funds “running and trickling” to varying degrees.

To establish and improve the supervision of fundsLong-term mechanism, Intensify the crackdown, Qinghai Provincial Health Insurance BureauborrowReflecting on the practice of the National Health Insurance Bureau, Qinghai Province issued unannounced inspection measures, unannounced inspections were organized within the province, and inspections were carried out at the lower level to provide guidance and supervision, which will further strengthen the fraudulent activities of various designated medical institutions, health insurance agencies and insured personnel. China’s high-pressure situation has formed a long-term mechanism for the supervision of health insurance funds.

Oversight of medical security funds Unannounced inspection refers to the supervision and inspection of the use of medical security funds by designated medical institutions and health insurance agencies and their personnel and persons insured by medical security departments in all levels without notice.

There are 14 articles in the “Unannounced Inspection Measures of Qinghai Medical Security Fund Supervision (Trial)”. By clarifying the scope of inspection and authority of health insurance departments at all levels, actively invite the participation of health, public safety, drug supervision and other relevant departments, scientifically formulate inspection plans and Carry out carry out inspection preparations, conduct inspections on key links and weak links, and treat them in accordance with laws and regulations, to provide compliance and lay a solid foundation for comprehensive implementation of the next level of oversight of medical safety funds and unannounced inspections, and to promote fine, precise and accurate health insurance fund monitoring. precise.

The “Measures for the Government to acquire supervision services of the medical insurance fund from the social forces (trial)” consists of 8 chapters and 40 articles, approvedOpen tender、Competitivenegotiation、Single source acquisitionIntroduce third-party forces with qualifications and conditions to participate in fund oversight work such as special governance, unannounced inspections, etc., and take full advantage of the human resources and professional advantages of third-party forces for internal and external efforts .longThe robbery made it impossible to hide fraud and insurance fraud.

The promulgation of the two “Measures” of the Qinghai Provincial Health Insurance Bureau is of great importance for the establishment and improvement of the supervision mechanism of the Qinghai Province health insurance fund. In the next step, the Qinghai Province Health Insurance Bureau will make great efforts to implement the implementation and make use of unannounced inspections.Third party serviceThe advantages of inspection, accelerate the transformation of practical results, realize the benefits of supervision,Social benefit、Economic benefit“Three victories”.

(Source: China News Network)

(Responsible editor: DF524)