Strengthening prevention and handling of violations of insurance policy fraud

Vietnam Social Security has just issued Official Letter No. 2155/BHXH-TTKT to the directors of Social Security of provinces and centrally-run cities on continuing to strengthen prevention, detection and handling of violations of social insurance, health insurance (HI), and unemployment insurance (UI).

Accordingly, Vietnam Social Security requires directors of provincial Social Security agencies to continue to thoroughly grasp and strictly implement the directives issued by Vietnam Social Security; at the same time, urgently implement the following contents:

Thoroughly grasp and request affiliated units and all civil servants and public employees of the provincial Social Insurance to enhance their sense of responsibility, comply with professional procedures and legal regulations in performing their duties; promptly detect violations of the law on social insurance, unemployment insurance, and health insurance; regularly update, be vigilant and have solutions to prevent and stop violations of social insurance and health insurance that are becoming increasingly sophisticated and complicated; at the same time, strictly handle organizations and individuals with violations according to the law (if any).

Further strengthen inspection and surprise checks, promptly and strictly handle violations, especially late payment and evasion of social insurance, unemployment insurance and health insurance in accordance with the direction of the Government at the regular meeting in May 2023 with localities (Resolution No. 88/NQ-CP of the Government). Thereby, resolutely sanction administrative violations or transfer files to competent authorities to sanction administrative violations for acts of law violation. In case of detecting acts with signs of crime, prepare a file to propose prosecution to the competent authority according to the instructions in Official Dispatch No. 239/BHXH-PC of Vietnam Social Security on instructions for receiving and processing information: Prepare and send a file to propose prosecution.

Enhance the exploitation of data analysis results of the Health Insurance Appraisal Information System, evaluate, select, and identify medical examination and treatment facilities (KCB) with abnormal increase in costs; increase in the indications for tests, diagnostic imaging, abnormal increase in the rate of inpatient treatment (compared with the average admission rate in the province or equivalent hospitals of the same model, same class, same level nationwide); unreasonably long inpatient treatment days; phenomenon of collecting patients; use of drugs, medical supplies with high winning bid prices compared to other localities at the same time... to organize surprise inspections, periodic inspections. Direct professional departments and district Social Insurance to fully exploit software applications when reviewing and approving social insurance regimes and paying health insurance examination and treatment costs. Actively collect statistics, review, and regularly monitor the issuance of social insurance leave certificates of medical facilities, especially private medical facilities in areas with many businesses and employees. In case of detecting signs of violations, promptly report to the Provincial and Municipal People's Committees and coordinate with the Department of Health and relevant agencies to conduct inspections, checks, and verifications: If violations are detected, closely consolidate records, documents, and refer them to local police agencies for further investigation and handling.

Proactively grasp the situation, direct the implementation of inspections and cross-checks of unusual cases and risks in social insurance and unemployment insurance benefits to promptly detect cases of creating fake or fictitious records to take advantage of social insurance and unemployment insurance. Synchronously deploy solutions to develop social insurance participants, urge collection, reduce late payment and evasion of social insurance. Report and advise local Party committees and authorities to issue documents to rectify units that allow late payment and arrears of social insurance, unemployment insurance and health insurance to persist, affecting the legitimate rights and interests of social insurance, unemployment insurance and health insurance participants.

Strictly and fully implement the contents of Regulation No. 01/QCPH-BCA-BHXH between the Ministry of Public Security and Vietnam Social Security on coordination in performing the tasks of protecting national security, ensuring social order and safety, fighting and preventing crimes in the fields of social insurance, unemployment insurance, health insurance and the coordination plan and program between the Provincial Police and the Provincial Social Security; regularly and flexibly coordinate activities, promptly exchange and provide the police with information, data, records, documents or phenomena showing signs of violations of the law on social insurance, unemployment insurance, health insurance for verification, investigation and prosecution in accordance with the provisions of law and the spirit of the Resolution of the 5th Session, 15th National Assembly; At the same time, strengthen coordination with the police agency to organize surprise interdisciplinary inspection and examination teams on social insurance, unemployment insurance, and health insurance to proactively prevent, detect, and promptly handle violations of social insurance, unemployment insurance, and health insurance according to regulations. Enhance the sense of responsibility, public ethics, and strict compliance with discipline and order of civil servants, public employees, and workers, especially leaders.

Spring Binh

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