Chengdu To Investigate Cheating The Social Security Fund Provides

Original Language Title: 成都市查处骗取社会保险基金规定

Read the untranslated law here: http://www.chinalaw.gov.cn/article/fgkd/xfg/dfzfgz/201506/20150600399269.shtml

Chengdu to investigate cheating the Social Security Fund provides

(November 25, 2013 the 24th Executive meeting of the Municipal Government of Chengdu on November 29, 2013, Chengdu municipal people's Government, the 180th published since January 1, 2014) first (objective basis)

    To strengthen the management of social security funds, regulating social security supervision and inspection, maintenance of social security insurance fund, according to the People's Republic of China Law on social insurance and the People's Republic of China labour contract law and other laws and regulations, Chengdu practice, these provisions are formulated.

Article II (scope of application)

    To cheat within the administrative area of the city of supervision of social insurance funds to investigate, these provisions shall apply.

Article III (duties)

Supervision and inspection of the municipal social security administration Department is responsible for the city's social security fund, responsible for investigating fraud organization, guidance and coordination of the work of the social insurance fund; the district (City) County and the social security administration within the Department responsible for the administration of social insurance fund supervision and inspection.

The municipal and district (City) county administrative departments of social insurance institutions to assist social security social insurance fund supervision and inspection.

    Health, food and drug, home, population and family planning, public security, industry and commerce, medical, financial, pricing, auditing and supervision departments in the context of their respective responsibilities to assist social security administration units supervise and inspect and individuals defrauding the social security fund.

Fourth (defrauding the social insurance fund)

The following acts belong to defraud social insurance fund:

(A) the labor relations in fiction or provide false evidence of fraudulent social security insurance eligibility;

(B) concealment, fabricated history, forged, altered, unauthorized alteration of personal identification and archival material, as well as other fictional insurance conditions, obtaining insurance eligibility;

(C) enjoy social insurance treatment condition changes or loss of enjoyment of social insurance benefits eligibility, did not inform the social insurance agency, continue to enjoy social insurance benefits;

(D) forging or fraudulently using social security documents or proof of payment;

(E) the social security documents or proof of payment to the others, for obtaining social security benefits;

(F) false, false, inflated social security services and the amount of fraudulent Social Security Fund;

(VII) labor relations in fiction or provide false evidence or expert opinion, for others to defraud insurance social security eligibility or enjoy social insurance benefits eligible for help;

    (VIII) other acts of obtaining social security funds.

Fifth (investigative measures)

Social Security Administration to investigate acts of obtaining social security funds, the right to take the following measures:

(A) to enter and investigate places related to the investigation, inspection, inspection, investigation, inspection asked the persons concerned;

(B) review relating to the management of the social insurance fund accounting vouchers, account books, financial statements, and other information relevant to the management of social insurance fund;

(C) requires investigation, inspection units and individuals to provide documents associated with the investigation, inspection, and provide an explanation and description, if necessary, may issue a survey book;

(D) recording, audio, video, photographic or replication, and collect the related information and data;

(E) commissioned a social agency investigation, inspection audit matters;

    (Vi) other investigation, inspection measures taken in accordance with law.

Sixth (survey)

Social Security Administration Department staff to conduct investigations, inspections, shall be not less than two persons, and shall show the certificate of administrative law enforcement, making the investigative records.

    Social security administration staff member under investigation unit or individual has a direct interest, should be avoided.

Seventh (administrative process)

    Social security administration according to the results of the investigation, inspection, and on acts of obtaining social insurance fund ordered corrective action or the decision on administrative penalty according to law; a suspected crime, it shall be handed over to judicial authorities.

Eighth (working hours)

Social Security Administration to investigate acts of obtaining social security funds, shall be completed within 60 days from the day of filing; the case is complex, and approved by the social security administration head, you can extend the 30th.

    Identification, audit time for facts, not included in the cases prescribed in the previous period.

Nineth (Agency handler) Social insurance agencies for acts of obtaining social security funds, to carry out the audit of social insurances; refused to accept the check or not with the audit work units and individuals, should be promptly reported to the social security administration according to law.

Social insurance agencies based on the audit results, you can pause, stop payment of social insurance benefits or costs associated with a decision, and commissioned by the social security administration ordered to refund the social insurance fraud; should be given administrative punishments according to law, reported to the Social Security Administration Department shall make the decision on administrative penalty.

Violation of designated medical institutions, retail pharmacy services agreement, in accordance with the agreement.

    Finds the illegal facts are not established by law, the social insurance agency shall, within five working days for it to carry out a replacement, Supplement social security costs associated with treatment or procedure.

Tenth (right)

Social security administration units or individuals defrauding the Social Security Fund Act before making a decision of administrative penalty, ought to listen to the unit or individual statements, representations provisions of laws or regulations should be hearing, shall inform unit or individual shall have the right to request a hearing; units or individuals to request a hearing, the social security administration departments shall organize the hearing.

    Units or individuals to the social insurance agency to suspend, stop payment of social insurance benefits or expenses not satisfied with the decision, the right to apply for review or apply for administrative reconsideration or bring administrative proceedings.

11th (reports Awards) The municipal and district (City) report to the county people's Governments shall establish a reward system, all units and individuals have the right to report this to the social security administration and the social insurance agency acts of obtaining social security funds. Reported and verified by the Social Security Fund fraud whistleblower shall be rewarded.

    Specific incentives enacted by the municipal social security Administrative Department in conjunction with the municipal finance department.

12th (secrecy)

Social security administration and the social insurance agency and its staff receive, when handling the case, shall comply with the following requirements:

(A) the non-disclosure of informant information such as name, company, address;

(B) not to report to the unit or person under investigation under investigation to produce material;

    (C) publicity or reward informants, in addition to consent of the consent of the informants, shall not express or implied public informers in the form of name, company, address, and other information.

13th (integrity records) Social security administration and the social insurance institution shall establish the insurance units and individuals obey the file integrity, focus management units and individuals have a bad record.

    Units or individuals defrauding the social security fund in serious cases, the social security administration administrative penalty according to law, shall be announced to the public; and information units should be subject to administrative punishment Chengdu city, into the enterprise credit information system for publishing.

14th (defrauding pension fund liability)

Recipients of old-age insurance benefits or other personnel of any of the following acts, social insurance agencies should immediately stop their old-age insurance benefits paid, commissioned by the social security administration ordered to return deadline has been defrauding pension, and by the social security administration fined not more than the amount defrauded more than twice times five times:

(A) fraud, irregularities for the retirement procedures;

(B) to hide the fact that recipients of old-age insurance benefits, malicious repeat pensioners;

(C) after the death of retired persons, their relatives or others in obtaining basic old-age pension;

    (D) to hide the fact that recipients of old-age benefits, repeat for dependent persons hardship grants.

15th (one of defrauding medical insurance liabilities)

Medical insurance or other personnel of any of the following acts, medical insurance agency authorized by the social security administration ordered its return to defraud Medicare, meanwhile, suspended its medical network from 12 months to 24 months clearing and by the social security administration fined not more than the amount defrauded more than twice times five times:

(A) will my social security card lending fake hospital or handle outpatient special illnesses, home care visits;

(B) forging or fraudulently using social security card in hospital or handle outpatient special illnesses, home care visits;

(C) concealing, fabricated history, forged, altered medical records, documents and other relevant documents, basic medical insurance treatment of false impersonation;

(D) obtaining other acts of basic medical insurance fund.

    Suspended its medical expenses during my first advance, and then to the place of insurance medical insurance agency audit claims.

16th (obtaining medical insurance liabilities bis)

Designated medical institutions and their staff, one of the following acts, medical insurance agency authorized by the social security administration ordered its return to defraud Medicare and the Social Security Administration Department shall order rectification, fined not more than the amount defrauded more than twice times five times in serious cases, by the social security administration canceled their fixed-point medical institutions qualified, not accepted within five years of its designated medical institutions eligible to apply:

(A) make up medical records, providing false reports and false certification, such as the diagnosis of disease;

(B) falsification of financial instruments or documents;

(C) collecting insured persons social security cards, fictitious claims data;

(Iv) serious violations of the human resources and social security, health, food and drug, price regulation, adverse effects;

    (E) other serious consequences or major irregularities.

17th (obtaining medical insurance liabilities of c)

Of appointed retail drugstores and his staff of any of the following acts, medical insurance agency authorized by the social security administration ordered its return to defraud Medicare and the Social Security Administration Department shall order rectification, fined not more than the amount defrauded more than twice times five times in serious cases, by the social security administration to cancel its qualification of appointed retail drugstores, inadmissibility of appointed retail drugstores in five years eligible for:

(A) violations of drug pricing policy, fraud, resulting in loss of basic medical insurance funds;
(B) private network settlement or non-designated retail pharmacies into medical insurance settlement;

(C) cash for the insurance swindler personal accounts;

    (D) other serious consequences or major irregularities.

18th (obtaining the work injury insurance fund liabilities one)

Work-related injury insurance agency finds employers, injured workers or their close relatives of any of the following acts shall immediately cease work injury insurance benefits paid, commissioned by the social security administration ordered to back of work injury insurance fraud, and by the social security administration fined not more than the amount defrauded more than twice times five times:

(A) the employer, injured workers fake, forged, altered, unauthorized alterations to the original documents, obtaining work injury certification conclusions and work identification of;

(B) the surviving dependent relatives of employees fiction, forged, altered, illegally changing the original documents are, enjoy the benefits of dependent relative pension eligibility;

(C) injury treatment clients receive work-related injury insurance conditions change or loss after treatment eligibility, himself or herself or to continue to receive treatment or other forms of obtaining treatment of work-related injury insurance;

(D) lend an imposter doctor in the my social security card, configuration of assistive devices;

    (E) obtaining the work injury insurance fund other acts.

19th (obtaining the work injury insurance fund liabilities bis)

Work-related injury insurance agency found that work-related injury insurance medical institutions, work-related injury insurance agreement assistive devices configured body, work-related injury insurance rehabilitation agency, one of the following acts shall immediately cease work injury insurance benefits paid, commissioned by the social security administration ordered to back of work injury insurance fraud, and by the social security administration fined not more than the amount defrauded more than twice times five times:

(A) not required authentication protocols work injury status causing false treatment, configuration of assistive devices;

(B) make up medical records, falsified certificates or credentials, and other means of obtaining the work injury insurance fund;

    (C) obtaining the work injury insurance fund other acts.

20th (maternity insurance fund fraud liability)

Maternity insurance agency employer, insurance, medical institutions have one of the following acts shall immediately stop maternity insurance benefits paid, commissioned by the social security administration ordered to return fraud, such as maternity benefits, and by the social security administration fined not more than the amount defrauded more than twice times five times:

(A) the employer or insurance, forged, fictitious, altered, proof of illegal changes to the original material and other means of obtaining maternity insurance benefits;

(B) to lend my social security card fake medical treatment of others;

(C) medical institutions not required to verify the insurance status causing false medical treatment;

(D) medical institutions make up medical records, falsified certificates or credentials, and so on means of obtaining maternity insurance fund;

    (E) other acts of obtaining maternity insurance fund.

21st (defrauding the unemployment insurance fund liabilities)

Unemployment insurance agency found that after the loss of eligibility of beneficiaries of unemployment insurance benefits, I or others continue to receive or otherwise obtain unemployment insurance benefits, shall immediately stop the unemployment insurance benefits paid, commissioned by the social security administration ordered to return in obtaining unemployment insurance who refuses to return, by the Social Security Administration Office of less than 500 Yuan more than 1000 Yuan fine.

    Conditions do not qualify for unemployment insurance benefits, forged documents, units and individuals defrauding the unemployment insurance benefits, social insurance agencies commissioned by the social security administration ordered to return in obtaining unemployment insurance, and by the social security administration fined not more than the amount defrauded more than twice times five times.

22nd (other offences) Human resources service institutions and the related organization and personal fictional labor relationship or provides false proved material, cheat social security parameter insurance qualification or cheat enjoy social security treatment qualification of, social insurance handling institutions should suspended its social security registration qualification, and return related personnel social security parameter insurance or received social security treatment of qualification, by social security administrative sector delegate ordered its returned cheat of social insurance, and by social security administrative sector at cheat amount twice times above five times times following of fine; plot serious of,

Social insurance institution social insurance registration should be cancelled.

Social security administration departments, public security, industry and commerce, civil affairs departments on a regular basis for human resources services and related joint organizations and individuals to carry out special checks, found to be in violation of the People's Republic of China labour contract law and the People's Republic of China social security law and other laws, regulations, rules and regulations and the circumstances are serious, it shall revoke the license, business license or registration certificate.

On violation this provides 16th article subsection (a) items provides of directly is responsible for of competent personnel and other directly responsibility personnel has practice industry qualification of, by Ministry of health door according to People's Republic of China social security method, and People's Republic of China practice industry physician method of provides, law revoked its practice industry qualification; on violation this provides 16th article provides of State-owned medical institutions head, by its competent sector according to institutions staff disposition provisional provides give demerit and the above disposition.

    Other acts in violation of these provisions, in accordance with the provisions of the relevant laws, rules and regulations.

23rd (safeguards)

Any of the following acts, by the Social Security Administration Department of correction which are (a) to (c) acts, punishable by fines of less than 2000 Yuan and 20,000 Yuan:

(A) unreasonable resistance, blocking social security administration department investigate obtaining social security fund in accordance with this Act;

(B) not in accordance with the social security administration to submit relevant documents, disguising the truth, provide false testimony or conceals or destroys evidence;

(C) by the Social Security Administration Department of correction refuses to, or refusing to comply with a decision of administrative handling of the social security administration;

(D) retaliating against whistle-blowers, complainants.

Violation of the provisions of the preceding paragraph, activities contravening public security management by the public security organs shall be subject to administrative penalties for public security.

    Social Security Administration Department in accordance with legal authorization to units or individuals defrauding the social security acts involve a compulsory administrative measure against the assets of the Fund.

24th (administrative)

Social Security Administration, social insurance agencies or streets, towns, social service agency staff cheating or colluding with others to defraud the social security fund or in dealing with cheating the social security fund in case one of the following acts by the supervisory authorities in accordance with the relevant provisions of administrative sanctions constitutes a crime, criminal responsibility shall be investigated in accordance with law:

(A) fails to perform or not to perform their duties, seriously affecting the investigation work carried out;

(B) accept bribes, abuse of power, fraud, negligence, malpractice;

(C) was obtained in investigating the leak in the discharge of responsibilities and privacy of the personal information and/or;

(D) disclosure of reported information, affect the investigation work carried out or whistleblower retaliation;

(E) avoidance system was not executed, resulting in unfair investigation work;

    (Vi) other acts in violation of regulations, should be given administrative sanctions.

25th (supervision)

    Recovery of social insurance fund should be transferred in full within ten working days of the financial accounts of the Fund of social insurance, and accept supervision by the Audit Department.

26th (implementing rules)

    Chengdu municipal Bureau of human resources and social security can be based on detailed rules for the implementation of these provisions.

27th (execution date) These provisions come into force on January 1, 2014. December 21, 2009, Chengdu, Chengdu municipal people's Government released the investigation obtain social insurance fund regulations (municipal 165th) repealed simultaneously.