Strictly handle acts of profiteering from social insurance and health insurance funds

On June 4, Vietnam Social Security (VSS) announced that it has just sent Official Dispatch No. 1623/BHXH-CSYT to the Ministry of Health regarding violations in issuing Certificates of Leave for Social Insurance.

Specifically, according to the report of Dong Nai province's Social Insurance, the issuance of social insurance leave certificates for 6 general clinics in Dong Nai province is not in accordance with regulations. Specifically: patients who do not go to the clinic are still issued social insurance leave certificates; doctors who do not go to work at the clinic still sign social insurance leave certificates; even when not sick, they still prescribe tests, diagnostic imaging, drugs... to take advantage of social insurance and health insurance funds.

Regarding this matter, Vietnam Social Security has issued many documents directing Social Security agencies of provinces and centrally-run cities to regularly review, inspect, and closely coordinate with relevant agencies. In particular, regarding the issuance of Social Security Leave Certificates of 6 polyclinics in Dong Nai province since May 2022, Dong Nai Social Security proactively coordinated with relevant agencies to detect and transfer to Dong Nai Provincial Police.

To ensure compliance with legal policies and regulations, Vietnam Social Security recommends the Ministry of Health as follows:

Direct medical examination and treatment facilities under the Ministry of Health and the Departments of Health of provinces and centrally run cities to rectify medical examination and treatment facilities in the area to strictly implement the Law on Medical Examination and Treatment, the Law on Health Insurance, the medical examination and treatment procedures of the Ministry of Health and strictly prohibit acts of profiteering from the Social Insurance and Health Insurance funds.

Direct the Department of Health of provinces and cities to strengthen inspection and examination of the implementation of health insurance coverage for health care facilities in the area, especially private health facilities.

For medical facilities identified as having committed acts of profiteering from the Social Insurance and Health Insurance Fund, the Department of Health shall coordinate with the Social Insurance of the province and city to strictly handle them according to the provisions of law (handling administrative violations in the health sector according to the provisions of Decree No. 117/2020/ND-CP dated September 28, 2020 of the Government; Article 23 of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government).

In order to strictly handle the violation in Dong Nai, on June 3, Dong Nai Department of Health sent an urgent document to the provincial Social Insurance Department agreeing to temporarily suspend the health insurance treatment contract for 4 private clinics in Bien Hoa city, including: Tan Long General Clinic, Long Binh Tan (Long Binh Tan ward); Tam Duc (Tan Hiep ward) and My Duc International General Clinic (Long Binh ward), due to the case of issuing fake leave certificates to take advantage of the social insurance and health insurance funds.

The implementation period is from June 3 until the Social Insurance and the Department of Health of Dong Nai province have new documents and notices based on the conclusion of the competent authority on the behavior of profiteering from the Social Insurance and Health Insurance funds of the above clinics./.

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