Regulation pursuant to § 252 (5) of the Fifth Book of the Social Code for the examination of contributions pursuant to § 252 (2) sentence 2 of the Fifth Book of the Social Code (Examination Regulation other contributions)

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SGB5 § 252Test V

Date of completion: 21.05.2013

Full quote:

" Regulation pursuant to § 252 (5) of the Fifth Book of the Social Code for the examination of the contributions pursuant to § 252 (2) sentence 2 of the Fifth Book of Social Code (Examination Regulation other contributions) of 21 May 2013 (BGBl. I p. 1377) "

Footnote

(+ + + Text proof: 28.5.2013 + + +) 

  

Unofficial table of contents

Input formula

Pursuant to Article 252 (5) of the Fifth Book of the Social Code, which is based on Article 1 (12) (b) of the Law of 15 December 2008 (BGBl. I p. 2426), the Federal Ministry of Health is responsible for: Unofficial table of contents

§ 1 Principles

The authorities responsible for the examination in accordance with Article 274 (1) of the Fifth Book of the Social Code have to carry out the examination in accordance with Section 252 (5) of the Fifth Book of the Social Code in accordance with uniform standards. Unofficial table of contents

§ 2 Subject and scope of the examination

(1) The subject matter of the examination is the assessment of contributions, the introduction of contributions and the forwarding of contributions pursuant to § 252 (2) sentence 2 of the Fifth Book of the Social Code (other contributions) by the health insurance funds. The test shall be carried out as a sampling test. In doing so, the monetary damage resulting from incorrect processing is determined on a case-by-case basis. (2) The examination facilities lay down the criteria for the sample and its scope after hearing the Federal Insurance Office and the top association. Union of health insurance companies. The examination facilities may specify test areas. (3) In addition to the sampling test, systematic errors in the contribution processing are to be carried out in appropriate sub-areas. The results of the examination for systematic errors shall be forwarded to the competent authority. (4) The examination facilities shall examine each financial year. (5) Each sickness insurance fund shall be considered at least every four years. Unofficial table of contents

§ 3 Special examinations

The Federal Insurance Office may propose special examinations for individual health insurance companies to the examination bodies, provided that there is a reasonable reason to do so. If the examination bodies reject the proposal, the reasons for rejection shall be justified. Unofficial table of contents

Section 4 Implementation of the examination

(1) The examination facility shall normally carry out the examination after prior notice. (2) The examination facility shall request the data from the health insurance company when announcing the examination,

1.

from which the sample is drawn and

2.

necessary to check for systematic errors.

(3) The examination facility shall set a time limit for the transfer of the data to the health insurance fund. The sickness insurance fund passes the data within the time limit to the examination facility. (4) The test facility draws the sample. Eight weeks before the examination, the health insurance company shall send the health insurance a list of the members selected for this examination and shall set a time limit for the transfer of the documents required for the examination. The sickness insurance fund shall make available to the examination facility the documents, including personal data, within the time limit set. Unofficial table of contents

§ 5 Rights and obligations of the examination bodies

(1) The examination facilities are entitled to collect, process and use the personal data required for the performance of the examination in accordance with § 4 and the preparation of the audit report and the audit report according to § 6. (2) The Examination facilities shall inform the Federal Insurance Office by 30 November of a year of its scheduling with regard to the examinations provided for the following year. Unofficial table of contents

§ 6 Audit report, examination notice

(1) Each examination institution which has carried out an examination shall retain the result of the examination in a written report (test report) and shall forward it to the Federal Insurance Office. The audit reports shall include in particular the reasons for the erroneous calculation of contributions for each individual case and the calculation of the amount of the damage. (2) The test report shall be submitted to a final interview of the examination facility with the Sickness fund precede. If changes or additions result therefrom, these must be taken into account in the audit report accordingly. The examination facility shall send a copy of the test report to the health insurance company. (3) On the basis of the test report, the Federal Insurance Office shall issue the examination notice and send it to the health insurance fund. The Bundesversicherungsamt (Federal Insurance Office) asserts the monetary damage resulting from the examination and, if carried out, the statement of the statement pursuant to § 7 (correction amount) in the examination notice. The examination facilities provide the Federal Insurance Office with the necessary information on request, which is necessary for the preparation of the examination certificate. (4) The Federal Insurance Office as well as the examination facilities are entitled to receive the information from the To keep health insurance funds and the test reports for so long until the test procedure is finished and the test certificate is passed. After that, the data shall be deleted immediately. (5) The examination facilities shall, after hearing the Federal Insurance Office, determine the details of the form and content of the audit reports. Unofficial table of contents

Section 7 High-calculation of test results

(1) The Federal Insurance Office may carry out an audit of the test results. In this case, the monetary damage recorded in the sampling test in accordance with § 2 (1) shall be calculated on the basis of the totality of the respective group of members in accordance with Section 252 (2) sentence 2 of the Fifth Book of Social Code of this health insurance fund. The Federal Insurance Office stipulates that an extrapolation shall only take place if the erroneous or non-plausible cases exceed a certain quota. (2) The Federal Insurance Office makes the correction amount resulting from the extrapolation. (3) The Bundesversicherungsamt (Federal Insurance Office), after hearing the top association, regulates the federal insurance office of the health insurance funds. Unofficial table of contents

§ 8 Correction of the high account by full collection; deadlines

(1) The sickness insurance fund may, in the case of a payment obligation of the correction amount, the underlying contribution fixing, the contribution entry and the forwarding of contributions in respect of the total insurance portfolio pursuant to Article 252 (2) sentence 2 of the Fifth Correct the Book of the Social Code in the context of a full survey. Whether a full survey is carried out, it shall inform the Federal Insurance Office within three months of receipt of the examination certificate in accordance with § 6 (3). (2) The sickness insurance fund shall inform the health insurance fund that no full survey is carried out or does it allow the health insurance to be carried out in accordance with the provisions of Article 6 (3). in the second sentence of paragraph 1, the amount of the correction referred to in the notice of examination shall be deemed to have been definitively fixed. Otherwise, the time limit for the execution of the full survey is one year after receipt of the audit certificate. (3) If the examination facility determines the correct correction, it shall inform the Federal Insurance Office accordingly. The sickness insurance fund shall return the amount of the correction made. Otherwise, the amount of the correction referred to in the examination notice shall be deemed to be finally fixed. (4) The correction shall be deemed to have been carried out correctly if the examination facility responsible for the examination of the health insurance fund has to do so to the Federal Insurance Office. The reason for a re-drawn sample in accordance with § 2 (1) is confirmed; the sample must have been drawn within ten months of the full survey. Unofficial table of contents

§ 9 Force Survey

The sickness insurance fund shall immediately remedy the deficiencies identified during the examination and make arrangements to ensure that the deficiencies noted do not repeat itself. The audit facility and the Federal Insurance Office shall be informed immediately of the measures taken. Unofficial table of contents

§ 10 Use of the correction amount

The amount of the correction goes to the health fund. A possible interest loss resulting from the difference between the provisional correction amount and the result of the full survey shall remain with the sickness insurance fund. Unofficial table of contents

Section 11 Cooperative obligations of health insurance funds

(1) The health insurance companies are obliged to keep the documents required for the examination up to the examination and to submit them at the beginning of the examination. (2) The examination facilities may, after hearing the Federal Insurance Office and the top association, be submitted. The Federal Government of the Health Insurance Fund determines that the health insurance companies provide the data to be checked electronically and in a certain form. (3) The health insurance companies have their records according to the requirements of the Social security accounting regulation in such a way as to provide an overview of the Formal and factual accuracy is guaranteed. The bookings and recordings must be made in full, correct, in a timely and orderly manner; this is also true in the case of accounting procedures which are carried out with the aid of automatic facilities. (4) The health insurance funds are obliged to inform the presentation of cash accounts and accounts and, in the case of procedures implemented with the assistance of automatic facilities, provide the necessary training programmes and appropriate assistance for the purpose of the examination (5) The sickness insurance fund shall have the appropriate means to carry out the test infrastructure, in particular a suitable room or place of work, as well as the necessary tools and the necessary staff free of charge. It has access to a data processing system and access to a data processing system and access to the examiners in compliance with data protection regulations, in particular § 78a of the Tenth Book of Social Code to provide the necessary data. Unofficial table of contents

§ 12 Entry into force

This Regulation shall enter into force on the day following the date of delivery. Unofficial table of contents

Final formula

The Federal Council has agreed.