Recently, the Guangdong Provincial Medical Security Bureau and the Guangdong Provincial Department of Finance issued the detailed rules for the implementation of the Interim Measures of the Guangdong Provincial Medical Security Bureau and the Guangdong Provincial Department of Finance on the reward for reporting fraud and defrauding medical security funds (hereinafter referred to as the detailed rules), which made it clear that whistleblowers can be rewarded according to the percentage of the defrauded fund, and the maximum amount of reward shall not exceed 100000 yuan. The detailed rules for implementation shall come into force on March 1 this year and shall be valid for three years. The detailed rules for implementation specify that the medical security administrative departments at all levels of the province can accept citizens, legal persons or other social organizations to report, and the reported objects include three types of subjects: medical security agencies, designated medical institutions and their staff in the province, as well as individuals. Which acts are suspected of fraud to defraud the medical security fund? In the detailed rules for implementation, fraud and insurance fraud are divided into five categories, such as medical security agencies and their staff handling medical security treatment procedures for personnel who are not within the scope of medical security; Designated medical institutions and their staff induce or assist others to fake or falsely seek medical treatment or purchase drugs, and decompose hospitalization, excessive diagnosis and treatment, over prescribing drugs and repeated charges for the purpose of defrauding medical security funds; For the purpose of defrauding the medical security fund, an individual gives his medical security certificate to others under false names, or repeatedly enjoys medical security treatment. The detailed rules for implementation are not applicable to the situation where the informant is the administrative department of medical security, the supervision and management organization, the handling organization and its staff. The detailed rules for implementation specify that the administrative department of medical security shall reward the qualified informants according to a certain proportion of the amount of fraud and insurance fraud verified in the reporting clues, which is specifically divided into three levels, and the maximum reward for the informants in each case shall not exceed 100000 yuan. There should be three specific conditions for the informant to meet. Third, the medical security fund at all levels has not been found or verified to avoid the loss caused by the reported medical security fund. Level I, level II and level III awards will be awarded at 6%, 4% and 2% of the amount of medical insurance fund verified to be defrauded, with the minimum amount of 500 yuan, 400 yuan and 300 yuan. In addition, if the informant is an internal or former internal staff of a designated medical institution, a competitive institution and its staff and meets the conditions, it can be increased by 1%. If it is found that the violation of laws and regulations does not cause the loss of medical security fund or avoid the loss of medical security fund due to reporting, but the report is true, a reward of 200 to 1000 yuan can be given according to the situation. According to the implementation rules, informants can make real name or anonymous reports to medical security agencies, the location of designated medical institutions and superior medical security administrative departments through official websites, telephones, apps and other means. (Xinhua News Agency)
Edit：Huang Huiqun Responsible editor：Huang Tianxin
Source：southcn.com
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