Hangzhou City Basic Medical Security Violation Approach

Original Language Title: 杭州市基本医疗保障违规行为处理办法

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(January 24, 2008 Hangzhou municipal people's Government at the 22nd Executive session on February 1, 2008 Hangzhou people's Government announced order No. 241, come into force on the date of promulgation) first in order to ensure the security of the basic medical insurance fund, protect the legitimate rights and interests of basic medical insurance, according to the People's Republic of China and other relevant laws and regulations of the provisions of the law on administrative punishment, combined with the city's actual, these measures are formulated.
    Article within the administrative area of the city in violation of the basic provisions of the medical care system, in accordance with this approach.
    Basic medical security system in these measures, including the basic medical insurance system for urban employees (including medical insurance of migrant workers), urban resident basic medical insurance system, the difficulties of new rural cooperative medical care system and medical assistance system. Third municipal labor and social security administrative departments are responsible for the city's basic medical insurance management. All districts and counties (cities) in the labour and social security administrative departments are responsible for the co-ordination of basic medical security management.
    Health care agencies at all levels are responsible for the overall daily management of basic medical insurance in the region.
    Health, civil affairs, finance, taxation, price, food and drug administration, education, industry and commerce, and public security Administrative Department of Auditors in accordance with their respective responsibilities, to coordinate the implementation of these measures.
    Administrative departments of labor security may entrust the co-ordination of area health care agencies, designated medical institutions, appointed retail drugstores charge, medicines, basic health care services, price supervision and inspection, to investigate the acts of violation of the provisions of the basic medical insurance system and penalties.
    Fourth article participate in basic medical guarantees of units (following referred to employing units) forged proved, and provides false proved or false, and heavy reported medical of, by Medicare handling institutions recovered violations spending of basic medical guarantees Fund, and by labor guarantees administrative sector on employing units sentenced 5000 Yuan above 20000 Yuan following of fine, on directly is responsible for of competent personnel and other responsibility people respectively sentenced 500 Yuan above 2000 Yuan following of fine.
    V article basic medical guarantees parameter insurance personnel (following referred to parameter insurance personnel) and the other personnel has following behavior one of of, by Medicare handling institutions recovered violations spending of basic medical guarantees Fund, and by labor guarantees administrative sector sentenced 500 Yuan above 2000 Yuan following of fine: (a) will I of basic medical guarantees card (card) lending to others using, or will I basic medical guarantees treatment to others enjoy of; (ii) forged or take with others of basic medical guarantees card (card) visits of; (Three) through repeat visits, or forged, and altered, and damage medical instruments, means, distribution take and I disease inconsistent, and and basic medical guarantees system provides inconsistent of drug, and machinery, or excess distribution take drug, and machinery, or cheat and I disease inconsistent, and and basic medical guarantees system provides inconsistent of medical service of; (four) sold basic medical guarantees drug directory within drug, and machinery, or sold basic medical guarantees service project within medical with material, and service project of; (five) refused to tie labor guarantees administrative sector, and
    Health supervision and inspection agencies, in the supervision and inspection process refused to provide or wilful damage of medical instruments and other information, (vi) other acts that violate the provisions of the basic medical insurance system. Sixth article Sentinel medical institutions and staff has following behavior one of of, except by Medicare handling institutions recovered violations spending of basic medical guarantees Fund, and by its violations costs accounted for Medicare handling institutions month audit medical of proportion, deduction its month application allocated of medical outside, plot serious of, by labor guarantees administrative sector on its statutory representative people and directly responsibility people respectively sentenced 500 Yuan above 2000 Yuan following of fine, plot special serious of,
    By labor guarantees administrative sector and at canceled its Sentinel medical institutions qualification: (a) diagnosis and treatment, and accounting Shi not check basic medical guarantees card (card) of; (ii) will non-parameter insurance personnel of medical or non-basic medical guarantees Fund paid range of costs included basic medical guarantees Fund paid range of; (three) allows or condoned fake visits, and titular Hospital of; (four) will not meet hospital conditions of parameter insurance personnel received live admitted, or will meet discharged conditions should to discharged of parameter insurance personnel continues to stranded Hospital of;
    (Five) reception Shi not review parameter insurance personnel yiqian of records records, or repeat to drug, or non-for clinic need for check, and treatment, or repeat check, and treatment of; (six) reception Shi not records records, or records records not clear, and not full, and and prescription or occurred of medical inconsistent, or occurred of medical and illness inconsistent of; (seven) due to price violations caused basic medical guarantees Fund loss of; (eight) not by prescription management provides issued prescription, or excess rationing drug, and machinery of;
    (IX) providing substandard and counterfeit medicines to patients, medical device or medical materials; (j) refuses to meet the administrative departments of labor security supervision and inspection, health care agencies, in the supervision and inspection process refused to provide or wilful damage of medical instruments and other information and (11) other acts that violate the provisions of the basic medical insurance system.
    Designated medical institutions and their staff to get cash or supplies, health tonics and other non-basic medical Security Fund payment of costs included in the basic medical insurance fund Act, or by a forged, altered medical records, documents, reports, and other means of obtaining basic medical insurance fund, appointed medical institutions of labour and social security administrative departments should cancel its qualifications. Seventh article Sentinel retail pharmacy and staff has following behavior one of of, except by Medicare handling institutions recovered violations spending of basic medical guarantees Fund, and by its violations costs accounted for Medicare handling institutions month audit medical of proportion, deduction its month application allocated of medical outside, plot serious of, by labor guarantees administrative sector on its statutory representative people and directly responsibility people respectively sentenced 500 Yuan above 2000 Yuan following of fine, plot special serious of, By labor guarantees administrative sector and at canceled its Sentinel retail pharmacy qualification: (a) not check basic medical guarantees card (card) of; (ii) not by prescription provides distribution (sale) drug, and machinery, or Super dose distribution (sale) drug, and machinery of; (three) will non-basic medical guarantees Fund paid range of costs included basic medical guarantees Fund paid range of; (four) to patients provides fake drug, and machinery or medical with material of; (five) not implementation price management sector provides of drug, and machinery or medical with material price,
    Causing loss of basic medical Security Fund (vi) refuses to meet the administrative departments of labor security supervision and inspection, health care agencies, in the supervision and inspection process refused to provide or wilful damage of medical instruments and other information; (VII) other acts that violate the provisions of the basic medical insurance system.
    Appointed retail drugstores and his staff get cash or supplies, health tonics and other non-basic medical Security Fund payment of costs included in the basic medical insurance fund Act, or by a forged, altered medical records, documents, reports, and other means of obtaining basic medical insurance fund, the labor Security Administration should cancel the qualification of appointed retail drugstores.
    Eighth article Medicare handling institutions and staff has following behavior one of of, by labor guarantees administrative sector ordered its deadline corrected, save economic loss, plot serious of, on directly is responsible for of competent personnel and other directly responsibility people respectively sentenced 500 Yuan above 2000 Yuan following of fine, and law give administrative sanctions: (a) not by provides will basic medical guarantees fee into parameter insurance personnel personal account and related Fund (funds) account of;
    (Ii) unauthorized relief or not by provides program verification employing units and parameter insurance personnel should paid of basic medical guarantees fee of; (three) unauthorized change basic medical guarantees standard or not by provides implementation basic medical guarantees Fund paid standard of; (four) deliberately delay paid Sentinel medical institutions, and Sentinel retail pharmacy should funding items of; (five) using positions and work of will seek self-interest of; (six) for work dereliction of or violation discipline caused basic medical guarantees Fund loss of;
    (VII) other acts that violate the provisions of the basic medical insurance system.
    Nineth labor Security Administration Department and other relevant administrative departments of personnel who abuse their powers, neglect their duties, engage, by their work units or by the competent authorities, supervisory organs shall be investigated for their administrative responsibilities.
    Tenth article violates basic provisions of the medical care system, relate to other laws, regulations, law by the relevant authorities. 11th to encourage units and individuals for violations of the provisions of the basic medical insurance system for reporting.
    Provide clues to the report is true and is not authority to master, and administrates the units or individuals provide major clues and evidence of an offence, the administrative departments of labor security in accordance with the relevant provisions of incentives, and for its secrecy. 12th these measures come into force on the date of promulgation.
                                                            Hangzhou City people's Government of the people's Government of Hangzhou City, November 30, 2003, the 199th publishing, November 30, 2004, the Hangzhou people's Government order No. 217, modifications of the Hangzhou City basic medical insurance scheme at the same time abolish.