Chengdu To Investigate Cash Social Insurance Fund Provides

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

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Chengdu to investigate cash social insurance fund provides

    (December 3, 2009, Chengdu municipal people's Government at the 54th Executive meeting on December 21, 2009, Chengdu municipal people's Government, the 165th promulgated as of February 1, 2010) the first (objective basis)

    To strengthen the management of social security funds, regulating social security supervision and inspection, maintenance of social security insurance fund, in accordance with the People's Republic of China labor law and the provisions of the Ordinance and other laws and regulations on labor security supervision, Chengdu practice, these provisions are formulated.

    Article II (scope of application)

    Investigation of acquiring social insurance fund activities in the administrative area of the city, these provisions shall apply.

    Article III (duties)

    Municipal labor and social security administrative departments are responsible for the city's investigation of acquiring social insurance fund organization, guidance, supervision and coordination of district (municipal), County labor and social security administrative departments responsible for retrieving the administrative supervision of social insurance funds.

    The municipal and district (City) County and the social insurance agency has specific responsibility for the audit of social insurances and verification of cash social insurance fund.

    Food and drug regulation, population and family planning, health, public security, industry and commerce, finance, auditing and supervision departments in the context of their respective responsibilities, and assist in the administrative departments of labor and social security units and individuals obtain social insurance fund supervision and inspection.

    Fourth (cash social insurance fund)

    The following acts belong to obtain 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, illegal change of personal identification and documents are, enjoy social insurance benefits eligibility;

    (C) enjoy social insurance treatment of fiction;

    (D) enjoy social insurance treatment condition changes or loss of social security benefits eligible, do not follow the required time to inform the social insurance agencies, continue to enjoy social insurance benefits;

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

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

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

    (H) provide false evidence or expert opinion, to help others to defraud insurance;

    (IX) other acts of acquiring social insurance fund.

    Fifth (terms of reference)

    Administrative Department of labour and social security to investigate acts of acquiring social insurance funds, the right to take the following measures:

    (A) according to law into subjects relating to inspections of sites and the investigation, inspection, investigation, inspection asked the persons concerned;

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

    (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 (investigation and withdrawal system)

    Labour and social security Administrative Department staff to conduct investigations, inspections, shall be not less than 2, and shall show the certificate of administrative law enforcement, making the investigative records.

    Labor and social security administration staff member under investigation unit and individual has a direct interest, should be avoided.

    Seventh (administrative procedures)

    Administrative Department of labour and social security should be based on the results of investigations, inspections, to get Social Security Fund Act made the following decision:

    (A) administrative penalties needed, make a decision of administrative penalty according to law;

    (B) be corrected and uncorrected, shall be ordered to correct or make the appropriate decision for administrative penalty according to law;

    (C) minor and has been corrected, no administrative penalty;

    (D) the illegal facts are not established and not subject to administrative penalties.

    Found does not belong to the administrative matter for the departments of labor and social security, should be transferred to the relevant departments in a timely manner; suspected of a crime, it shall be handed over to judicial authorities.

    Eighth (working hours)

    Administrative Department of labour and social security to investigate acts of acquiring the social insurance fund, shall be completed within 60 days from the date of filing; on the complexity of the case, approved by the head of the Administrative Department of labour and social security, you can extend the 30th.

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

    Nineth (social security agency handlers) Social insurance agencies to obtain social security funds, the audit of social insurances according to law.

    Audit results by the social insurance agency and submitted to the approval of the Administrative Department of labour and social security, you can pause, stop payment of social insurance benefits or costs associated with a decision, and ordered to return the cash social insurance fund; should be given administrative punishments according to law, the labour and social security administrative departments shall make the decision on administrative penalty.

    Finds the illegal facts are not established by law, social insurance agency shall, within 5 working days a replacement social insurance benefits or related costs.

    Tenth (right)

    Administrative Department of labour and social security to units or individuals obtain social security Fund Act before making a decision of administrative penalty, ought to listen to the unit or individual statements, representations provisions of laws and regulations should be heard according to law, shall inform unit or individual shall have the right to request a hearing; units or individuals to request a hearing, the labor and social security administration departments shall organize the hearing.

    Administrative Department of labour and social security, after administrative punishment decision on unit or individual, unit or individual has the right to apply for administrative reconsideration or bring an administrative suit.

    11th (reports Awards) Any unit and individual have the right to labour and social security administrative departments and social insurance institutions to report acts of acquiring the social insurance fund. Report system of incentives established by the Government, to report cash social insurance funds and verified the whistleblower reward.

    Specific incentives set by the municipal Bureau of the municipal labor and Social Security Bureau.

    12th (informants information security system)

    Labour and social security administrative departments and social insurance agencies and their staff to accept, 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) Labour and social security administrative departments and social insurance institutions should set up insured units and individuals abiding by good faith files, units and individuals have a bad record for key management.

    Units or individuals obtain social insurance fund if the circumstances are serious, Administrative Department of labour and social security administrative penalty according to law, shall be announced to the public.

    14th (acquiring legal responsibility of social insurance fund)

    Units or individuals to obtain insurance or obtaining social security fund, the Administrative Department of labour and social security ordered to return, fined not more than the amount defrauded more than 1 time 3 times.

    After the loss of treatment of beneficiaries of social insurance benefits eligibility, I continue to receive treatment or other forms of cheating or other social insurance benefits, social insurance institutions to stop treatment immediately and ordered to pay the amount refund recipients; refusing to return overdue, legally recovered by the social insurance agency, and by the labor and social security administration fined 500 Yuan more than 1000 Yuan fine.

    15th (false claim old-age insurance benefits liability) On fraud violations handle retired procedures of personnel, social insurance handling institutions should immediately stopped basic pension, and deadline recovered or from its yihou should received of basic pension in the gradually deduction has impersonator of pension insurance; retired personnel death Hou, its relatives or others impersonator basic pension of, social insurance handling institutions should ordered impersonator who deadline returned, and by labor and social security administrative sector give 500 Yuan above 1000 Yuan following fine

    ; Refusing to return overdue impersonation of the old-age insurance and the performance of the labor and social security administration punishment decision, Administrative Department of labour and social security law to the people's Court for compulsory execution.

    16th (insurance for urban and rural residents obtain health insurance fund liability)

    Basic medical insurance for urban and rural residents in any of the following acts, by the health insurance agencies to recover it from the basic medical insurance fund in respect of reimbursement of medical expenses incurred by the labor and social security administration fined 200 Yuan fines:

    (A) will my social security card lending fake hospital or handling clinic specific diseases;

    (B) forging or fraudulently using social security card or handle outpatient hospitalization of particular diseases;

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

    (D) other acts of acquiring funds of basic medical insurance.

    17th (town of legal liability of the insured employee obtain medical insurance fund)

    Urban workers ' basic medical insurance personnel or other persons to one of the following acts, by the health insurance agencies to recover it from the basic medical insurance fund in the guise of medical expenses by the labor and social security administration fined 200 Yuan more than 1000 Yuan fine, and depending on the seriousness of, suspend it from 6 months up to 24 months of basic medical insurance treatment:

    (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) reimbursement of medicines sold by medical insurance fund, gain unfair advantage, resulting in loss of medical insurance funds;

    (E) other acts of acquiring funds of basic medical insurance.

    18th (designated medical institutions and their staff to obtain medical insurance liabilities)

    Sentinel medical institutions and staff has following behavior one of of, by medical insurance handling institutions law recovered its from basic medical insurance fund in the gets of costs, by labor and social security administrative sector ordered rectification, sentenced violations amount 1 to 3 times times of fine, on directly responsibility personnel at 500 Yuan above 2000 Yuan following fine; plot serious of, by labor and social security administrative sector canceled its Sentinel medical institutions qualification, 5 years within shall not grant its Sentinel medical institutions qualification:

    (A) would not be admitted to indications of the insured persons hospitalized or meet discharge indication should be discharged from insured persons stay in hospital;

    (B) not complying with the provisions of the identification ID card causing an impostor and social insurance card, hanging-bed hospital;

    (C) the virtual mind cost, SWOP drug or diagnosis and treatment projects, forging certificates or credentials of defrauding medical insurance funds;

    (D) accidents, traffic accidents, medical accidents, women's childbearing costs covered by basic medical insurance payment;

    (V) medical insurance does not pay for drugs, medical projects and modifications to the health insurance fund to pay medical services facilities;

    (Vi) private network settlement or the inclusion of non-medical costs of settling medical insurance;

    (VII) do not meet the conditions of the insurance officers home care or handling specific diseases;

    (H) the verifying there is no medical records or medical records and medical expenses is inconsistent;

    (I) the use of special diseases of excess purchase, prescribe a lift, transfer of medical bills, profiting;

    (10) not according to the drug's actual name, quantity, price, drive or drive your charging instruments;

    (11) the violation of the provisions of basic medical insurance, resulting in loss of basic medical insurance fund other acts.

    19th (appointed retail drugstores and their staff to obtain medical insurance liabilities)

    Sentinel retail pharmacy and staff has following behavior one of of, by medical insurance handling institutions law recovered its from basic medical insurance fund in the gets of costs, by labor and social security administrative sector ordered rectification, sentenced violations amount 1 to 3 times times of fine, and on directly responsibility personnel at 500 Yuan above 2000 Yuan following fine; plot serious of, by labor and social security administrative sector canceled its Sentinel retail pharmacy qualification, 5 years within shall not grant its Sentinel retail pharmacy qualification:

    (A) not complying with the prescription (sale) drug or overdosing with (sell) drugs, unauthorized prescriptions;

    (B) not according to the drug's actual name, quantity, price, drive or drive your charging instruments;

    (C) violation of drug pricing policies, fraud, resulting in loss of basic medical insurance funds;

    (D) private network settlement or the inclusion of non-medical costs of settling medical insurance;

    (E) for persons insured accounts under the guise of cash;

    (Vi) use the personal account of the insured person to pay other personal account use fees;

    (VII) other acts in violation of the provisions of basic medical insurance.

    20th (acquiring the work injury insurance fund liabilities one)

    Work-related injury insurance agency finds employers, injured workers or their immediate family members of any of the following acts, immediate cessation of work injury insurance benefits paid and the Administrative Department of labour and social security ordered to return, fined not more than the amount defrauded more than 1 time 3 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, forging, altering, unlawfully altered original documents to defraud pension eligibility for treatment;

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

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

    21st (acquiring the work injury insurance fund liabilities bis)

    Work-related injury insurance agency found that work-related injury insurance services agreement medical institutions, assistive devices the protocol configuration mechanism, injury recovery Protocol bodies of any of the following acts, immediate cessation of work injury insurance benefits paid by the labor and social security administration canceled their designated service eligible amount and ordered to return the treatment of work-related injury insurance, fined not more than the amount defrauded more than 1 time 3 times:

    (A) is not required to verify patient identity causing false hospital;

    (Ii) does not comply with the indications of injury admission officers hospitalized or hanging-bed hospital;

    (C) case of drug or diagnosis and treatment projects, exist in name only, or decomposition rate, and manpower costs expenditures outside the scope of the Fund to funds clearing;

    (D) providing medical services for drug abuse or excessive;

    (E) fiddling expenses item or record does not match the content of the records;

    (F) violation of rules prescribing, making medical records, proof of false or instruments;

    (VII) AIDS for configuration items, amount and the injured part, actual configuration does not match the amount of projects;

    (H) violations of work-related injury insurance, work injury insurance fund losses caused by other acts.

    22nd (take maternity insurance fund liabilities) Participate in birth insurance of units violation about financial, and accounting, and statistics provides, forged, and variable made, and deliberately destroyed about books, and material, or not set books, led birth premium payment base cannot determine of, except by about legal, and regulations of provides give administrative punishment, and criminal punishment outside, also should by related provides levy paid birth insurance fee; delay paid of, by labor and social security administrative sector according to social security levy paid interim regulations of provides added received late fees,

    Directly responsible for the charge and the other persons fined 5000 Yuan and 20,000 yuan fine.

    Fraud, phishing and other units and individuals fraudulently maternity insurance benefits, or help obtaining maternity insurance benefits units, medical institutions, the Administrative Department of labour and social security ordered to return the maternity insurance benefits, fined not more than the amount defrauded more than 1 time 3 times.

    23rd (under false pretenses, or obtain unemployment insurance benefits liability)

    The unemployment insurance agency found that unemployment insurance benefits received after the loss of unemployment insurance eligibility, himself or herself or to continue to receive treatment or other forms of obtaining insurance, stop treatment immediately and ordered to pay refund refuses to return, the Administrative Department of labour and social security law and punishable by a penalty of 500 Yuan more than 1000.

    Conditions do not qualify for unemployment insurance benefits, forged documents, units and individuals defrauding the unemployment insurance benefits, the Administrative Department of labour and social security ordered to return, fined not more than the amount defrauded more than 1 time 3 times.

    24th (liability of intermediary organizations and individuals obtain social security fund)

    Agencies and related organizations and individuals, there are provisions of this article fourth cash social insurance funds, participation, expenditures of the Organization obtain insurance or obtaining social security fund, the Administrative Department of labour and social security ordered to return, fined not more than the amount defrauded more than 1 time 3 times; directly responsible for executives and other persons fined 5000 Yuan and 20,000 yuan fine.

    25th (other offences) Violation of the provisions of article 14th to 24th, and constitutes a crime, criminal responsibility shall be investigated according to law.

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

    26th (safeguards)

    Any of the following acts, the Administrative Department of labour and social security shall be ordered to correct which in part (a), (b) or (c) conduct, fined not more than 2000 Yuan and 20,000 Yuan:

    (A) unreasonable resists, obstructs the labour and social security administrative departments investigate obtaining social security fund in accordance with this Act;

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

    (C) correction by the labour and social security administrative departments refused to correct, or refusing to comply with a decision of administrative handling of the labour and social security administrative departments;

    (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.

    27th (enforcement)

    Labour and social security administrative departments may be authorized by law to units or individuals obtain social security acts involve a compulsory administrative measure against the assets of the Fund.

    28th (accountability)

    The social insurance institution or streets, towns, social service agency staff acquiring or colluding with others to obtain social security funds, in accordance with the first paragraph of this article 14th heavy punishment, directly responsible to draw the authority administrative sanctions constitutes a crime, criminal responsibility shall be investigated according to law.

    Administrative Department of labour and social security, social insurance agency staff investigation of acquiring one of the social insurance fund in case any of the following acts shall be given 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) disclosing business secrets obtained in the course of performing their duties and personal privacy;

    (D) disclosure of reported information, which whistle-blowers by retaliating against or affecting the investigation work carried out;

    (E) avoidance not according to stipulations, unfair investigation work;

    (Vi) other behaviors should be given administrative sanctions.
29th (supervision)

    Recovery of social insurance fund shall be transferred in full within 10 working days of the financial accounts of the Fund of social insurance, and accept supervision by the Audit Department.

    30th (explain)

    Specific problems in the application of these provisions by the Chengdu municipal labor and Social Security Bureau is responsible for the interpretation.

    31st (execution date) These regulations come into force on February 1, 2010.