Recently, the Fujian Provincial Medical Insurance Bureau and the Fujian Provincial Department of Finance jointly issued the "Implementation Measures for Reporting Rewards for Illegal and Irregular Use of Medical Security Funds in Fujian Province" (hereinafter referred to as the "Implementation Measures"), clarifying the scope of application of reporting rewards, principles, conditions, standards, distribution and collection procedures, as well as relevant supervision and management. What are the revisions and improvements in the new implementation measures compared to the Interim Implementation Measures for Reporting Rewards for Fraudulent and Fraudulent Medical Security Fund Activities in Fujian Province, which were introduced in 2019? The relevant person in charge of the Fujian Provincial Medical Insurance Bureau told reporters that the newly issued implementation measures have mainly been modified in the following four aspects: adjusting and expanding the scope of reporting rewards. The scope of rewards for reporting has expanded from fraudulent insurance practices to all illegal and irregular use of medical insurance funds. The informant reports and provides clues on suspected illegal and irregular use of basic medical insurance (including maternity insurance) funds, medical assistance funds and other medical security funds, as well as illegal and irregular use of resident serious illness insurance, employee large medical expense subsidies, civil servant medical subsidies and other medical security funds. If verified to be true, corresponding rewards will be given according to regulations. Divide the reward levels for reporting. According to the reported evidence and the investigation results of illegal and irregular facts, the rewards are divided into three levels. Among them, for providing detailed illegal and irregular facts, clues, and direct evidence of the reported person, assisting in the investigation and punishment work, and providing a first level reporting reward if the reported content is completely consistent with the illegal and irregular facts. Clearly define the methods and requirements for receiving rewards. The whistleblower can report under their real name or anonymously. If anonymous whistleblowers have a demand for reporting rewards, they should provide information that can distinguish their reporting identity as their identity code when reporting, and agree on the reporting password and contact information with a dedicated person from the medical insurance department. The medical insurance administrative department responsible for handling reports will strictly implement a confidentiality system, ensure the confidentiality of the identity and location of the recipients, and effectively protect the personal privacy of anonymous whistleblowers. Adjust the reward standards for reporting. The upper limit of the reward amount has been adjusted from 100000 to 200000, and the minimum reward amount has been increased from 100 yuan to 200 yuan. At the same time, clarify the proportion of rewards for each level, and provide a reward of 6% of the case value for first level reporting; The second level reporting reward will be given at 4% of the case value; The third level reporting reward will be given at a rate of 2% of the case value. If the informant is an internal staff member of a designated medical institution, designated retail pharmacy, or former internal staff member, the reward amount can be increased by 20% according to the reward standard. The relevant person in charge of the Fujian Provincial Medical Insurance Bureau stated that the medical insurance fund is a life-saving money for the people. The illegal and irregular use of the fund harms the common interests of the people. Cracking down on illegal and irregular activities not only requires the medical insurance department to take a heavy blow, but also to mobilize the masses to participate in social supervision. In order to facilitate people's reporting, medical insurance departments at all levels in Fujian Province have announced various reporting channels such as the Internet, telephone, fax and mail. In 2023, the medical insurance department of Fujian Province received 495 complaints and reports of illegal and irregular use of medical insurance funds, verified 100% of valid reports, and recovered more than 17.45 million yuan of medical insurance funds; According to regulations, 35 cases of reporting rewards were fulfilled, and a reporting bonus of 62000 yuan was distributed. (Lai Xin She)
Edit：GuoGuo Responsible editor：FangZhiYou
Source：gmw.cn
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