Beijing: Reporting illegal and irregular use of medical insurance funds can earn a maximum reward of 200000 yuan

2023-11-29

Recently, the Beijing Municipal Medical Insurance Bureau and the Beijing Municipal Finance Bureau jointly issued the "Implementation Rules for Reporting Rewards for Illegal and Irregular Use of Medical Insurance Funds in Beijing" (hereinafter referred to as the "Implementation Rules"), which clearly states that whistleblowers should report illegal and irregular use of medical insurance funds. If it is verified to be true, the maximum reward for each case shall not exceed 200000 yuan. The Implementation Rules specify that based on the amount of medical insurance fund losses that should be recovered in the reported matters, the whistleblowers who meet the conditions will be rewarded according to the entities causing the losses, divided into units and individuals. The maximum reward standard for reporting will be increased from 100000 yuan to 200000 yuan, and the minimum reward standard will be increased from 200 yuan to 500 yuan. Reports of all illegal and irregular use of medical insurance funds will be included in the reward scope. Among them, for reports of fund losses caused by designated medical institutions, designated retail pharmacies, medical insurance agencies, and insured units, with a case value of less than 500000 yuan (including 500000 yuan), a reward of 2% of the case value will be given. If the case value is less than 500 yuan, a reward of 500 yuan will be given; For cases with a case value of over 500000 yuan, a reward of 4% of the case value will be given. Reporting of medical insurance fund losses caused to insured individuals with a case value of less than 10000 yuan (including 10000 yuan) will receive a reward of 10% of the case value. If the case value is less than 500 yuan, a reward of 500 yuan will be given. For cases with a case value of over 10000 yuan, a reward of 10% of the case value will be given, and an additional reward standard of 500 yuan will be added on this basis. Within 10 working days after the investigation and verification of the reported matter, the department responsible for investigating the reporting clues shall investigate and verify the identity information of the whistleblower who is willing to receive the reporting reward, propose opinions on the proposed reward, and attach relevant materials to the case, and report to the municipal medical security administrative department. After reviewing the relevant materials, the municipal medical security administrative department shall notify the informant to go to the designated location to handle the confirmation procedures. Within 2 months from the date of receiving the reward notice, the whistleblower shall collect the reward with their valid identity certificate. When handling the procedures, they shall provide valid proof that can distinguish their identity, bank account information, etc. If entrusted to others for collection, the trustee must simultaneously hold a power of attorney from the informant, valid identification documents from both the informant and the trustee. If the informant fails to handle it within the prescribed time, it shall be deemed as automatic abandonment. After the informant completes the confirmation procedures, the municipal medical security administrative department will pay the reward funds to the designated account of the informant. When distributing reward funds for reporting, strict review should be conducted. If it is found that the reward for reporting is obtained through forging materials, concealing facts, or other methods, or there are other situations that do not meet the requirements for receiving rewards, the municipal medical security administrative department has the right to revoke the reward for reporting after investigation, and hold the parties responsible in accordance with the law. Reporter: Jie Li (Lixin News Agency)

Edit:GuoGuo    Responsible editor:FangZhiYou

Source:people.cn

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