By City Government 68th times Executive Conference considered, decided on Hangzhou City basic medical guarantees violations behavior processing approach part terms be modified: tenth article modified for: "violation this approach fourth article second paragraph provides of, by social security administrative sector ordered deadline corrected, sentenced 10,000 yuan above 30,000 yuan following fine, caused basic medical guarantees Fund spending of, by social security administrative sector ordered employing units returned cheat of basic medical guarantees Fund spending. "Violations of this article fourth paragraph, of obtaining basic medical insurance fund, by the social security administration ordered returned to defraud the basic medical insurance fund, fined a maximum of the amount defrauded more than twice times five times.

"This decision come into force on the date of promulgation.



The Hangzhou City basic medical security violation approach of making corresponding amendments in accordance with this decision, republished. Hangzhou City basic medical guarantees violations behavior processing approach (November 7, 2011 Hangzhou City Government makes No. 267, announced, according to October 9, 2016 Hangzhou City Government makes No. 297, Hangzhou City Government on modified straddling Hangzhou City basic medical guarantees violations behavior processing approach part terms of decided modified) first article for guarantees basic medical guarantees Fund of security, maintenance basic medical guarantees parameter insurance personnel of lawful rights and interests of, according to People's Republic of China social security method, and

Provisions of the Ordinance and other laws and regulations on labor security supervision, combined with the city's actual, these measures are formulated.

Basic medical security system in violation of the provisions of article's handling procedures apply.

Basic medical insurance in these measures refers to the integrated within the administrative area of the city basic medical insurance agency in the area of operation of the urban workers ' basic medical insurance, basic medical insurance for urban and rural residents and medical hardship relief.

Basic medical insurance fund in these measures, including the funds of basic medical insurance, major medical benefits fund transfers, medical hardship relief funds and basic medical insurance fund. Article city basic medical insurance of the Social Security Administration Department in charge of the city administration.

All districts and counties (cities) within the Social Security Administration Department is responsible for the co-ordination of basic medical security management.

The basic medical insurance agency is in charge of this co-ordinate the day-to-day management of basic medical security within the region, and according to basic medical insurance service agreement, designated medical institutions, appointed retail drugstores in monitoring implementation of basic health care services.

Health, civil affairs, finance, taxation, price, food and drugs, education, industry and commerce, public security Administrative Department in accordance with their respective responsibilities, to coordinate the implementation of these measures.

Fourth the employing unit shall, in accordance with the People's Republic of China Law on social insurance and the interim regulations on the collection and payment of social insurance and the provision of measures for the collection and payment of social insurance in Hangzhou, conduct basic medical insurance system for employees in this unit, and to pay medical insurance premiums.

Employer labor relations shall not issue false evidence or false financial statements, does not meet the condition of insured persons to participate in workers ' basic medical insurance or provide assistance to obtain basic health care treatment.

The employer shall not be forged, altered, altered medical records, medical bills or other documentation, obtaining basic medical insurance fund.

Article fifth insured person to a medical institution or to the designated retail pharmacies to buy drugs, should show basic medical insurance card (card). Parameter insurance personnel shall not has following behavior: (a) will I of basic medical guarantees card (card) lending others using, or will I of basic medical guarantees treatment transfer to others enjoy, for basic medical guarantees costs settlement; (ii) forged or take with others of basic medical guarantees card (card) visits, cheat basic medical guarantees treatment; (three) through forged, and variable made, and altered medical instruments, and medical notes, means, cheat basic medical guarantees treatment; (four) excess or repeat distribution purchased drug, and

Medical devices or medical materials, obtaining basic medical insurance fund (v) sold by the basic medical insurance costs medicines, medical equipment, medical materials or diagnosis and treatment projects, obtaining basic medical insurance fund, (vi) other violations of basic medical security system of obtaining basic medical insurance fund.

Not eligible for insured persons should not be used to provide false evidence of participation in basic medical insurance agency in charge of the city basic medical insurance, obtain basic health care benefits; non-insured persons shall not use another person's basic medical insurance card (card) or forged basic medical insurance card (card) for treatment.

Designated medical institutions in the sixth section when meeting patients should verify the basic healthcare insurance officer basic medical insurance card (card), review medical records, check, determine the treatment plan according to the conditions, in accordance with prescribed regulations prescribed and conditions recorded in the medical record.

Designated retail pharmacies selling drugs, should verify the basic healthcare insurance officer basic medical insurance card (card), review medical records, according to the illness requires placing non-prescription drugs or prescriptions issued by the designated medical institutions placing drugs and documented in the medical record.

Seventh article Sentinel medical institutions, and Sentinel retail pharmacy shall not has following behavior: (a) used for parameter insurance personnel repeat registered, repeat or no refers to levy laboratory, and check, and treatment, decomposition or no refers to levy hospital, way, provides not necessary of medical service, for basic medical guarantees costs settlement; (ii) violation basic medical guarantees system provides, will basic medical guarantees Fund paid range or agreed service range yiwai of clinic project, and medical service facilities by produced of costs into basic medical guarantees costs settlement; (Three) violation basic medical insurance medication range or medication varieties provides, to excess medication, and repeat medication, and violations using no indications of drug, or to decomposition, and change prescription, way, for parameter insurance personnel dispensing, for basic medical guarantees costs settlement; (four) violation basic medical guarantees system provides of paid proportion for basic medical guarantees costs settlement; (five) over provides of clinic project, and drug, and medical devices, and medical with material price for basic medical guarantees costs settlement; (six) forged, and variable made, and

Altered medical instruments or provides false medical with settlement report, and credentials, cheat basic medical guarantees Fund spending; (seven) will life supplies, and health tonic, non-drug class items acts as a basic medical guarantees costs settlement range within of drug, and medical devices, and medical with material or clinic project, cheat basic medical guarantees Fund spending; (eight) privately will non-Sentinel medical institutions, and non-Sentinel retail pharmacy access basic medical guarantees information system, cheat basic medical guarantees Fund spending;

(IX) take other means to obtain basic medical insurance fund.

Article eighth designated medical institutions basic medical insurance service, designated retail pharmacy shall, in accordance with the provisions of the agreement, in accordance with requirements of information management system of the basic medical insurance system, and pharmaceuticals, medical devices, medical material, information management, connected with a basic medical security system, in accordance with the agreement to save, transmit information.

Basic medical insurance agency shall, in accordance with the provisions of article will be basic medical insurance fees transferred to the insured individual accounts and related funds or funds accounts, designated medical institutions in a timely manner, appointed retail drugstores to pay medical expenses.

Basic medical insurance handling institutions and staff shall not has following behavior: (a) unauthorized relief or not by provides program verification employing units and parameter insurance personnel should paid of basic medical guarantees fee; (ii) unauthorized change basic medical guarantees standard, or not by provides implementation basic medical guarantees Fund paid standard; (three) leaked employing units and parameter insurance personnel personal information; (four) using positions and work convenience seek self-interest; (five) other violation basic medical guarantees legal, and regulations of behavior.

Basic health insurance agencies and their staff shall not be fraudulent, forged documents or other means of obtaining the basic medical insurance fund.

Tenth article violates provisions of the second paragraph of this article fourth, rectification by the Social Security Administration Department, fined 10,000 yuan and 30,000 yuan fines, resulting in expenditure of basic medical insurance fund, returned from social security Administrative Department shall order the employer to defraud the basic medical insurance fund.

Violation of paragraph III of this article fourth fraudulent expenditure of basic medical insurance fund, by the social security administration ordered returned to defraud the basic medical insurance fund, fined a maximum of the amount defrauded more than twice times five times.

11th article violates this article fifth subparagraph (a) provided, 500 Yuan more than 2000 by the social security administration fined causing loss of basic medical insurance fund, by the basic medical insurance agency recovery of basic medical insurance fund.

Violation of the second paragraph of this article fifth part (b), (c), (d), (e), (f) and the provisions of the third paragraph, by the social security administration ordered returned to defraud the basic medical insurance fund, fined a maximum of the amount defrauded more than twice times five times.

Insured persons were suspected to have breached the provisions of article fifth, during the period of investigation, treatment, basic medical insurance agencies can change the basic medical insurance fee settlement.

12th disobey article sixth cause loss of basic medical insurance fund, by the basic medical insurance agency recovery of basic medical insurance fund, and more than 500 by the social security administration fined a maximum of 2000.

13th article violation this approach seventh article subsection (a) items, and subsection (ii) items, and subsection (three) items, and subsection (four) items, and subsection (five) items provides of, by social security administrative sector ordered deadline corrected, sentenced 500 Yuan above 2000 Yuan following fine; caused basic medical guarantees Fund loss of, by basic medical insurance handling institutions recovered basic medical guarantees Fund spending, and according to basic medical insurance service agreement of provides held corresponding of responsibility.
Violation this approach seventh article subsection (six) items, and subsection (seven) items, and subsection (eight) items, and subsection (nine) items provides of, cheat basic medical guarantees Fund spending of, by social security administrative sector ordered returned cheat of basic medical guarantees Fund spending, sentenced cheat amount twice times above five times times following fine; basic medical insurance handling institutions should and its lifted basic medical insurance service agreement, social security administrative sector should law canceled its Sentinel medical institutions, and Sentinel retail pharmacy qualification.

Designated medical institutions, appointed retail drugstores were suspected to have breached the provisions of article seventh, during the period of investigation, treatment, medical insurance agency can suspend the payment of medical expenses.

14th article violation this approach eighth article provides, Sentinel medical institutions, and Sentinel retail pharmacy not according to basic medical insurance service agreement provides established information management system of, basic medical insurance handling institutions should and its lifted service agreement; Sentinel medical institutions, and Sentinel retail pharmacy not by provides save, and upload drug, and medical devices, and medical with material information of, by social security administrative sector sentenced 500 Yuan above 2000 Yuan following fine.

15th article violation this approach Nineth article first paragraph, and second paragraph provides of, by social security administrative sector ordered deadline corrected, on directly is responsible for of competent personnel and other directly responsibility personnel law give disposition; caused basic medical guarantees Fund loss of, ordered recovered should paid of basic medical guarantees fee or recovered has paid of basic medical guarantees Fund spending; to employing units, and Sentinel medical institutions, and Sentinel retail pharmacy, and parameter insurance personnel caused loss of, law bear compensation responsibility.

Violate the provisions of paragraph III of this article Nineth, by the social security administration ordered returned to defraud the basic medical insurance fund, fined a maximum of the amount defrauded more than twice times five times. 16th designated medical institutions, appointed retail drugstores, basic health insurance agencies and their staff, insurance and other basic medical insurance fund swindler, crime, Social Security Administration Department should be promptly transferred to the judicial organs, criminal responsibility shall be investigated according to law; designated medical institutions, appointed retail drugstores and their staff in the course of implementation of the basic medical insurance system, and of violations of norms of practice,

Basic medical insurance agencies or social security administration department shall transfer the right to administrative departments.

Article 17th outside the administrative area of the city, signed with the city basic medical insurance agency service of basic medical insurance agreements contracted medical institutions, appointed retail drugstores in violation of the rules, basic medical insurance agency can suspend the payment of medical expenses, from the film location of the area transferred to the social security administration the social security administration departments dealt with according to law. 18th to encourage units and individuals for violations of the provisions of the basic medical insurance system for reporting.

Report is true and administrates the offered the main clues and evidence units or individuals, the social security administration shall be rewarded, and for its secrecy. 19th article this way come into force on the date of promulgation.





February 1, 2008, Hangzhou City, Hangzhou City basic medical insurance, issued by the people's Government of the violations approach (the Hangzhou people's Government order No. 241) repealed simultaneously.