Notice of the general office of the national health and Family Planning Commission on the supervision and inspection work of the new rural cooperative fund
People's Republic of China national health and Family Planning Commission
2016-12-05
In the letter, 2016 grassroots health office, No. 1287

Health and Family Planning Commission of the provinces, autonomous regions, Fujian Province, health insurance office:
In recent years, the operation mechanism of the new rural cooperative medical care system has been improved, and the ability to guarantee has been improved, which has played a positive role in deepening medical reform, reducing the burden of the masses and maintaining social stability. In recent years, with the increase in the total amount of funds, the flow of medical change, the new rural cooperative work is also facing some new situations and new problems. Recently some typical cases of illegal use of funds in some areas, reflecting the new rural cooperative management, there are still weak links, need to further strengthen the system construction, improve the management level. To learn lessons to prevent similar problems from happening again, in the new situation to strengthen the management of the fund, to further ensure the safety of the fund, I will carry out the supervision of the national new rural cooperative fund supervision special inspection. The relevant circumstances are hereby notified as follows:
Typical case report
(a) the illegal elements of the medical information to cheat the new rural cooperative fund. Since 2015, Fujian Province, Zhangzhou City prosecutors prosecution of fraud of NCMS funds cases 10 28 people were hospitalized for criminals through false invoices and other materials online shopping outside the province, the use of medical information network vulnerabilities, new criminal gangs and professional medical insurance gold swindle. Its main features are: one is the crime by means of "minor prescription" inflated costs to upgrade to forge "a set of" hospital medical insurance gold swindle ticket. The two is under the guise of serious illness to the provincial hospital for treatment, to avoid the information system audit. Such as the county's Procuratorate handled 9 cases of such cases are 3, through the treatment of cancer in the remote medical records for reimbursement. Three is through the network to form a chain of interests. Such as the Zhangpu County procuratorate Chen Zhilin 10 people fraud, Chen Zhilin Yao Wenjian persuaded in the home, the mother to provide insurance information for false invoices and smooth after the success of fraud, and take the initiative to act as references, to persuade the 9 lenders themselves or friends to provide insurance information, Yao Wen Jian made fake records together for medical compensation. And obtain the corresponding fee from.
(two) the individual medical institutions for medical fund. According to the "Xinhua Daily Telegraph" reported recently, Pumiao town of Yongning district hospitals in Nanning city were reported taking NCMS funds through the decomposition of hospital ", only in 2015 December there are more than and 200 people" a hospital, two case records ". Due to the local joint management office found in a timely manner, did not cause the loss of the new rural cooperative fund. After the incident, violations of Health Bureau of Yongning District Pumiao Town Health Hospital in the city health system has been criticized, in charge of the party and the government Pumiao town hospitals mainly were admonishing conversation, and asked the hospital president and Party branch secretary in charge of NCMS hospital leadership made a written review.
(three) grassroots village cadres misappropriation of farmers' health care costs. Jiang Yuan Zhen Shi Yu Cun Sichuan city in Chongzhou Province, 17, 18, 20 group leader Xie Zhiming, was trapped in the village of NCMS in 2014 receive personal payment of funds, causing the villagers to leak protection or downshift insured, involving 33 people, the amount of 5310 yuan. After the incident, Chongzhou City Party committee and government Jiang Yuan Zhen has carried on the investigation on the matter, Xie Zhiming ordered to refund all the amount, and the related medical expenses compensation, Jiang Yuan Zhen discipline give Xie Zhiming 1 years probation sanction.
In addition, according to the Ministry of Finance in 2015 for the country's urban residents and the new rural cooperative financial assistance fund audit case, Hebei, Henan and other places also appeared basic information loss and duplication of insurance and other issues.
The above cases in violation of state regulations, damage the vital interests of farmers as well as the new rural cooperative system confidence, resulting in the loss of the fund, the new rural cooperative work has a negative impact, the lesson is profound. All localities should earnestly draw lessons from typical cases, learn a lesson, strictly implement the main responsibility, strengthen the supervision to the use of the fund, related to the vital interests of the farmers a good run, to ensure the healthy development of new rural cooperative medical system.
Two, to carry out special supervision of the new rural cooperative fund supervision
Recent cases show that the new rural cooperative medical system is still in the regulatory system to be strengthened, the system needs to be improved, the construction of information technology lags behind, to crack down on illegal personnel and other issues. I proposed by the organization of self-examination and spot checks, focusing on the use of the new rural cooperative fund to carry out special inspection activities.
(a) self-examination. The Provincial Health Planning Commission will jointly finance, auditing, public security and other departments, with local conditions, through self-examination, cross examination, centralized checks and other forms, a comprehensive investigation of province (area) in the process of using the funds in risk. Specific as follows:
One is in strict accordance with the "new rural cooperative fund financial system", the "new rural cooperative fund accounting system" and "Ministry of Finance on the further strengthening of the new rural cooperative medical fund management advice" (Weinong Wei 2011 No. 52) requirements, one by one control and carry out the new rural cooperative fund supervision and management of inspection. Especially to strictly implement the audit report to pay the procedure and standard specification, position setting and the division of responsibilities, the establishment of a sound system, inspection system and accountability for violations of internal control system in the system, and resolutely blocked funds unreasonable loss channel.
Two is to strengthen the designated medical institutions, especially for township hospitals, village clinics and private medical institutions