The maximum can earn 300,000!The Medical Insurance Bureau cracks down on a new trick: hiring people to check the account and give a commission

The efforts of cracking down on defraudes in various places have become more and more stigma.

On July 5th, the Shaanxi Medical Insurance Bureau issued a notice of the "Measures for the Supervision of the Medical Insurance Fund from Social Power (Trial)". The Shaanxi side stated that due to the consideration of insufficient supervision forces, the Shaanxi Medical Insurance Bureau mobilized social forces to participate in supervision and entrusted third parties to verify the use of medical insurance funds.

The Medical Insurance Bureau not only publicly hired people to check the accounts, but also clarified the price: pay 400 yuan a day for labor expenses. It doesn't look, but there is no performance of the performance.

According to the policy of the Shaanxi Medical Insurance Bureau, in addition to basic service fees, third -party institutions can also get "performance rewards". "Performance" is reflected in the amount of recovery, and how many medical insurance funds are recovered by 5%, up to 300,000 yuan.

The reward is great.

"Fraud" supervision pressure is high

The introduction of social forces supervision of medical insurance funds is in line with the work requirements of the State Medical Insurance Bureau.

Prior to Shaanxi, many provinces and cities across the country have adopted similar practices. Buy third -party regulatory services to supervise the medical insurance fund.

Shenzhen is a faster city. Beginning in 2017, Shenzhen introduced third -party institutions to carry out the "nuclear card and satisfaction survey project". In November 2019, this project was bid by Min Tai'an Property Insurance Public Establishment Co., Ltd., with a bid price of 2 million yuan. Shenzhen feedback, due to the "nuclear card project", Shenzhen's 2019 inpatient accounting costs increased by 7%year -on -year compared with the same period of the previous year, and the growth rate of hospitalizations decreased by 8%.

In January 2020, the Guangdong Provincial Committee of the Agricultural and Industry Party suggested to promote the supervision of third -party institutions in society.

In March 2022, the Tongling Suburban Medical Insurance Bureau issued the "Implementation Plan on the introduction of normalization of third -party services to participate in the supervision of medical insurance funds", and the bidding price was 298,000 yuan/year.

These are the annual medical insurance supervision projects. Compared with these provinces, Shaanxi has increased supervision.

Shaanxi stipulates that the recruiting personnel check the first, second, and third -level medical institutions, and the number of days of verification is 2 days, 4 days, and 6 days, respectively, and the per capita daily salary standards are calculated at 400 yuan. After detecting fraud, the performance rewards were rewarded according to the recovery amount, up to 300,000 yuan.

Picture source: Shaanxi Provincial Medical Security Bureau

Shaanxi's reward amount has exceeded the highest reward for reporting fraud in the state.

On July 5th, the National Medical Insurance Bureau amended the "Interim Measures for the Reporting Reward of Fraud and Funding Fund", and the upper limit of the reward of the illegal behavior of the fraudulent medical security fund will be reported from 100,000 yuan to 200,000 yuan. Earlier, the provinces were rewarded to reporting fraud in accordance with the "maximum does not exceed 100,000 yuan".

Shaanxi obviously hopes to fight against cheating more, hoping to "have brave husbands under the reward".

However, Shaanxi has set a prerequisite for "performance commission": Third -level hospitals are recovered by less than 3 million yuan, no performance commission is given, and so on. None of them below.

This may mean that the "running and dripping" at a one -million -dollar of the medical insurance fund of the large hospital is already normal.

Third -party supervision is indispensable

Basic medical insurance purchase supervision services are the requirements of the Party Central Committee and the State Council many times.

In 2013, the General Office of the State Council issued the "Guiding Opinions on the Government's Purchase of Service to Social Power" to clarify the basic public services fields of education, employment, social security, medical care, housing security, cultural sports, and disabled services. Buy service from social forces.

The so -called "social power" is not what anyone can do. In July 2020, the State Council issued the "Guiding Opinions on Promoting the Reform of the Medical Security Fund Supervision System System", which defined the "third -party forces": information technology service agencies, accounting firms, commercial insurance institutions, etc. Governments at all levels are required to pay for performance at all levels to improve the professionalism, accuracy, and efficiency of supervision.

These regulations provide a basis for the supervision of medical insurance funds from social forces.

The National Medical Insurance Bureau does not only rely on social forces. After the establishment of the State Medical Insurance Bureau in 2018, it began to follow the practice of the State Drug Administration's inspection of pharmaceutical companies, and organized the "flight inspection" of medical institutions. Such an official inspection often involves third -party institutions.

In December 2021, the State Medical Insurance Bureau issued a draft of the "Flying Inspection" management measures to institutionalize the "Flying Inspection", which mentioned that it can hire qualified information technology service institutions, accounting firms, commercial insurance institutions, etc. Three -party institutions and professionals assisted in development.

Speaking of the National Medical Insurance Bureau, in the 2022 medical insurance "flying inspection" work launched in May this year, 30 inspectors from 30 inspectors came from third -party institutions, including medical, medical, finance, information and other professionals. Screening analysis and other work.

"China Social Security" in charge of the Ministry of Human Resources and Social Security has written a comment that the purchase of supervision services mainly solves the problems such as insufficient staffing and incomplete mechanism.

In recent years, the state's supervision of medical insurance funds has continued to increase.During the National Medical Insurance Bureau's special rectification operation in 2021, a total of 708,000 medical institutions were inspected throughout the year, 411,000 were investigated and punished, and 23.4 billion yuan of medical insurance funds were recovered.All this requires a lot of regulatory forces, and third -party institutions are one of the indispensable parts.The practice of Shaanxi Province may be followed up by more provinces and cities.

Writing | Zhang Ling

Edit ｜ Jiang Yun Jia Ting

Operation | Twenty -thirty

Illustration ｜ Visual China

### Medical Insurance Policy#

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