Use medical insurance card to use others?Sichuan New Regulations: Suspension of reimbursement!

@所有, please pay attention

Recently, Sichuan introduced medical security funds

Use credit management regulations

Give my medical insurance card to others for names

Repeat medical security treatment

Use the opportunity to enjoy medical security treatment to resold medicines

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These behaviors will be subject to credit punishment

On June 17, the reporter learned from the Sichuan Provincial Medical Security Bureau that in order to strengthen the supervision and management of the use of medical security funds, the bureau recently issued the "Interim Measures for the use of Credit Management of the Sichuan Provincial Medical Security Fund" (hereinafter referred to as the "Interim Measures"). In Sichuan's basic medical insurance (including maternity insurance) funds, medical rescue funds and other medical security funds use medical security funds for credit management.

Establish credit files for subjects such as insured personnel

According to the relevant person in charge of the Sichuan Provincial Medical Security Bureau, the use of credit management funds refers , Pharmacists and medical technicians, as well as medical insurance participants in the province conduct credit dynamic evaluation. According to the evaluation results, the credit supervision, credit rewards and punishments used by the medical security fund are determined.

According to the "Interim Measures", the Sichuan Provincial Medical Security Bureau will categorize the establishment of a credit security fund to establish a credit security file for medical insurance, targeted retail pharmacies, medical insurance insured personnel and other credit insured persons. The city (state) and county (city, district) medical insurance administrative departments are responsible for the review and update of credit archives in the district of their jurisdictions. The content of the credit files includes: credit commitment and its performance information, basic information, good behavior information, bad behavior information, evaluation information, historical credit information, credit monitoring information, etc.

Three behaviors of insured persons will be subject to credit punishment

In accordance with the "Interim Measures", the credit evaluation of medical insurance designated medical institutions, retail pharmacies and other institutions use a thousand -point system, and conduct classification and classification through evaluation indicators models and algorithms. , E Five. The credit evaluation of doctors, nurses, pharmacists, and medical technicians of medical insurance medical institutions, and medical insurance participants in the province adopts a percentage system to deduct the dishonesty behavior. , Credit attention, general dishonesty, severe dishonesty.

Medical insurance designated medical institutions and related staff, retail pharmacies, and medical insurance insured persons will be punished by credit after violating the use of relevant laws and regulations of the medical security fund.

Medical insurance insured persons are used to deceive the medical security fund to hand over their medical insurance cards to others and use them;

Repeat the treatment of medical security, and the overdue does not return, causing the medical insurance fund to lose;

Those who enjoy the opportunity to enjoy medical security treatment to resold drugs and accept cash, physical or other illegal benefits, will be suspended for a 3rd to 12 months of the network of medical expenses, and the credit rating will be lowered.

More news &&

The use of credit management funds using credit management is an important part of the construction of a long -term mechanism of fund supervision. In June 2020, the General Office of the State Council issued the "Guiding Opinions on Promoting the Reform of the Medical Security Fund Supervision System", which made an institutionalized arrangement on the use of credit management in the medical insurance fund. The evaluation system and the integration management system will associate the results of credit evaluation with budget management, inspection and audit, fixed -point agreement management, etc., forming a guarantee of rule of law, credit management, multi -form inspection, big data supervision, party committee leadership, government leadership, government The comprehensive supervision pattern of supervision, social supervision, industry self -discipline, and personal trustworthiness. In 2019 and 2020, some cities (states) in Sichuan Province launched a pilot work of the national and provincial fund supervision and credit system construction, and achieved reference experience and formable copying models.

Source: Sichuan Daily

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