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it has started! 6 illegal actions at designated drug stores

Release date: 2020-01-07 Views: 0

Source: Pharmacy Manager  

Recently, Zhejiang Medical Insurance issued the "Zhejiang Medical Insurance Administrative Penalty Discipline Standards", which provides rules for the scam insurance, forgery insurance registration and other six illegal behaviors.

According to the "Discretion Benchmark", for lighter illegal acts, a fine of 2 times (inclusive) or more and 3 times less than the amount defrauded shall be imposed.

For general illegal acts, a fine of 3 times (inclusive) or more and 4 times the amount of the deception is imposed.

For serious illegal acts, a fine of 4 times (inclusive) or more and 5 times (inclusive) or less shall be imposed.

Among the 6 violations, medical insurance agencies and social insurance service organizations such as medical institutions and drug dealers used fraud, forged certification materials, or other means to defraud medical insurance fund expenditures, and fraud, forged certification materials, or other means to defraud medical treatment The two penalties for guaranteeing treatment are the most serious. If there are two violations mentioned above, they will be fined at least twice.

That is to say, in the past cases, the designated pharmacies notified that the common fraudulent acts of falsifying illegal sales vouchers and drawing medical insurance funds would be divided by at least two times the fine.

Summarizing previous cases, the following actions constitute fraud.

1. In the process of providing medical insurance services by designated retail pharmacies, they stole funds from personal accounts of medical insurance, took cash for insured persons or purchased non-medical items such as nutrition and health products, cosmetics, daily necessities, and falsely invoiced insured persons. 4. Providing false invoices and other 4 acts are illegal and illegal.

2. Designated medical institutions falsely publicize, exaggerate the condition induction, deceive the insured persons to stay in hospital, apply for medical insurance treatment for uninsured persons, and record the medical expenses that should be borne by the individual into the scope of medical insurance payment. 8 kinds of illegal acts including fictional medical services, forgery of medical documents or bills.

3. During the medical treatment and drug purchase process, if the insured person forges fake medical service bills for reimbursement of medical expenses (off-site medical settlement), he will lend his medical insurance voucher to another person for medical treatment or take another person's medical insurance voucher for medical treatment. , It is also illegal.

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