Two departments set up a mechanism for investigating and prosecuting cases of fraudulently obtaining medical insurance funds
Experts suggest to unify the criteria for identifying illegal and criminal acts of the medical insurance fund to ensure that the same case is convicted
□ Our reporter Hou Jianbin
The supervision of medical insurance funds is advancing in depth.
The National Medical Insurance Administration and the Ministry of Public Security recently jointly issued the "Notice on Strengthening the Investigation and Punishment of Cases of Defrauding Medical Insurance Funds" (hereinafter referred to as the "Notice"), requiring medical security administrative departments and public security agencies at all levels to attach great importance to the investigation and handling of cases of defrauding medical insurance funds. Work together to form a joint effort to crack down on illegal and criminal acts of fraudulently obtaining medical insurance funds in accordance with the law, and earnestly protect the people’s "money for medical treatment and life-saving".
The relevant person in charge of the National Medical Insurance Bureau pointed out that the "Notice" is for the National Medical Insurance Bureau and the Ministry of Public Security to adapt to the development of the new situation of medical insurance fund supervision, and to deepen the consultation mechanism, clue notification, information sharing, publicity and education, reward and punishment mechanism between the medical insurance department and the public security department. The specific measures of cooperation and cooperation are intended to speed up the construction of an operating mechanism for the organic connection of the medical insurance fund's administrative punishment and criminal justice, and to complement each other's advantages, and always maintain a high-pressure situation of combating illegal and criminal activities of the medical insurance fund.
Zhang Qing, a professor at China University of Political Science and Law, believes that administrative law enforcement and criminal justice are two different law enforcement methods in the process of combating illegal crimes of obtaining medical insurance funds by fraud. The deterrence of offenders can better safeguard the safety of the medical insurance fund and the legitimate rights and interests of the insured.
Preliminarily curb the frequent occurrence of fraud and insurance
In recent years, the National Medical Insurance Bureau and the Ministry of Public Security have continuously strengthened their cooperation to jointly combat illegal and criminal activities of fraudulently obtaining medical insurance funds, and initially established a high-pressure situation to combat medical insurance fraud and insurance fraud. The widespread and frequent occurrence of medical insurance fraud fraud cases has been initially curbed. , The supervision of medical insurance funds has achieved certain results.
"However, the regulatory situation of medical insurance funds is still severe, and illegal cases of fraudulent medical insurance funds still occur from time to time." The relevant person in charge of the National Medical Insurance Bureau said frankly that the medical insurance fraud cases in Cheng'an County, Hebei Province and Shanxian County, Shandong Province, warned us to crack down on illegal medical insurance fund fraud. The task of criminal behavior is still very arduous and requires constant attention.
The "Notice" was released under this background.
Lou Yu, a professor at the School of Civil, Commercial, Economics and Law of China University of Political Science and Law, and director of the Institute of Social Law, said that the medical insurance administrative department's supervision and management of the medical security fund needs to coordinate and cooperate with other departments, especially to establish communication and coordination with the public security organs, and transfer cases. Mechanism to do a good job in connection with executions.
Lou Yu further pointed out that for a long time, due to the lack of legal protection, the operation effect of this mechanism in our country is not satisfactory. It is mainly manifested in the following: on the one hand, the standards for the identification of illegal acts by the administrative and public security agencies are not uniform, and because of the latter Without professional knowledge, it is often difficult to judge the nature of the case transferred by the former, and many cases can only be ignored. On the other hand, the police force of the public security organs is limited, and the enthusiasm for filing, investigating, and investigating is even more lacking on the premise of being unable to characterize the case.
For this reason, the "Notice" requires that the medical insurance department and the public security department should deepen the cooperation and cooperation in the consultation mechanism, clue notification, information sharing, publicity and education, reward and punishment mechanism, etc., and accelerate the establishment of an organic connection between the medical insurance fund administrative punishment and criminal justice, and complement each other. Operating mechanism.
The time limit for filing and review is divided into 3 levels
For a long time, when medical insurance administrative agencies investigate and deal with cases of fraudulently obtaining medical insurance funds, if they find that the illegal act is suspected of committing a crime, whether to transfer the case after the administrative punishment or before the administrative punishment is completed, there are different opinions and practices in practice.
There is a view that medical insurance administrative agencies should implement administrative penalties before transferring them, so that the administrative agencies can effectively perform their duties, and both administrative and criminal penalties are conducive to enhancing deterrence against fraudulent insurance fraud.
However, there are also views that the realization of administrative and criminal double penalties will expand the scope of attack, which does not conform to the principle of "equal penalty", while relevant laws and regulations of our country generally require no double penalties, and that existing criminal penalties should be considered and absorbed. Administrative penalties.
Zhang Qing said that in order to resolve disputes over the transfer of the above-mentioned cases, the "Notice" clearly stipulates that medical security administrative departments at all levels "in the process of monitoring and enforcing medical insurance funds" have discovered that citizens, legal persons and other organizations are suspected of using medical insurance funds. If a crime is constituted, it shall be transferred to the public security organ at the same level in accordance with the law.
Zhang Qing explained that this requires the medical insurance administrative agency to transfer the transfer once it discovers that an illegal act is suspected of constituting a crime during the law enforcement process, and should not wait until the administrative punishment is completed before transferring it.
In addition, the "Notice" further stipulates the time limit for filing and review of cases transferred by administrative agencies by public security agencies, which is divided into three levels: for general cases, the time limit for filing and review of cases is still 3 days, and there are suspects that need to be verified in the second level. For cases with criminal clues, the time limit for filing and review shall not exceed 7 days. For the third level of “major, difficult and complicated cases”, the time limit for filing and review can be extended to 30 days with the approval of the person in charge of the public security organ at the county level and above.
In Zhang Qing’s view, the "Notice" stipulates different time limits for case filing and review according to the clues and complexity of different cases. This distinction takes into account the different requirements for certification standards in administrative cases and criminal cases, as well as diversification, The difference of different types of cases to the difficulty of obtaining evidence helps the public security organs to better decide whether to file a case within the time limit, that is, to improve the accuracy of the decision to file a case.
Establish a mechanism for the connection of execution contacts
The "Notice" clarified that the coordination mechanism for investigating and prosecuting cases of obtaining medical insurance funds by fraud should be improved.
Deepen the cooperation in the investigation and handling of transferred cases.
Medical security administrative departments and public security organs at all levels shall establish a mechanism for connection and contact persons for executions, and coordinate the investigation and handling of transferred cases.
Zhang Qing said that the execution contact mechanism can play a role as a bridge between the medical insurance administrative department and the public security organs on the one hand, and on the other hand, it can also supervise the medical insurance administrative agency to avoid the occurrence of "should be transferred" and "punishment in place of punishment". Phenomenon.
In addition, the joint meeting and information reporting system are also important mechanisms for smooth departmental communication.
The "Notice" stipulates that the joint meeting must not only be held regularly in terms of time, but also need to communicate the work of medical insurance cases in terms of content to achieve information sharing, and further solve the problem of difficulty in connection with execution from the perspective of information communication.
Zhang Qing pointed out that the joint conference system helps administrative law enforcement officers and criminal justice officers to reach a consensus on the remaining differences in medical insurance fraud cases, and to discuss differences on the standard of criminal case transfer in cases, so as to avoid problems caused by medical insurance supervision departments and criminal cases. The different perceptions of the judicial organs affect the transfer of cases, leading to evasion of legal sanctions for the perpetrators of medical insurance fraud.
The "Notice" stipulates the important responsibilities of the National Medical Security Administration and the Ministry of Public Security for improving social supervision.
Specifically, the two departments should strengthen the efforts to investigate and punish the fraudulent medical insurance fund policy publicity, encourage the mobilization of the whole people to participate in supervision, and actively report illegal and criminal acts of fraudulently obtaining medical insurance funds.
Improve the processing procedures for reporting clues, implement reporting incentives, and re-reward and quick awards in accordance with laws and regulations; strictly implement the confidentiality system for reporting, protect the legitimate rights and interests of reporters, and create a good atmosphere for social attention, participation, and support of fund supervision.
Zhang Qing said that if the fight against fraudulent insurance only relies on the law enforcement power of the administrative and judicial organs, it will be difficult to cover all fraudulent insurance activities and effectively curb the recurrence of illegal acts.
Therefore, it is necessary to improve social supervision.
It is necessary to increase the exposure of illegal and criminal cases of fraudulently obtaining medical insurance funds, do a good job in public opinion propaganda and guidance, and effectively play the role of warning and education, so as to better punish illegal and criminal acts and deter criminals.
The "Notice" has taken the first step in criminal execution cooperation in the field of supervision of my country's medical insurance funds.
Lou Yu suggested that in the future, it is possible to combine the joint meeting and the information notification system to attract experts in multiple fields such as medical technology, hospital management, law, and finance to jointly discuss and study the constituent elements of illegal and criminal behaviors of fraudulently obtaining medical insurance funds, and form a unified identification standard. The National Medical Security Administration and the Ministry of Public Security regularly publish typical cases and recommendations for identification, gradually realize the same sentence in the same case, and finally realize the coordination and connection between executions.