The latest announcement: the punishment regulations for designated drugstores are coming

Source: Jiangsu Medical Insurance Bureau Sorting out: saibelan - drugstore Manager The latest version of the supervision and management plan for designated drugstores has been released For retail drugstores, it focuses on supervising the behaviors of collecting, stealing and swiping social security cards, and inducing insured personnel to buy cosmetics and daily necessities In order to standardize the service behavior of designated medical institutions, safeguard the legitimate rights and interests of the insured and ensure the safety of medical insurance fund Recently, Jiangsu Medical Insurance Bureau issued the notice on Further Strengthening the agreement management of designated medical institutions (hereinafter referred to as the notice) The notice puts forward specific measures for the access, evaluation, supervision and management of designated medical institutions The notice made it clear that it is necessary to strengthen the supervision of the implementation of the agreement, focusing on the supervision of the behaviors of collecting, stealing and swiping social security cards, and inducing the insured to buy cosmetics and daily necessities At the same time, the notice stressed that the supervision and inspection of the implementation of the agreement of the designated medical institutions should be increased For those who violate the service agreement, the liability for breach of the agreement should be investigated strictly according to the agreement For the designated medical institutions that have confirmed the breach of the agreement, the inspection frequency should be increased appropriately It is worth noting that the provincial medical insurance bureau has also formulated the basic text of the unified agreement for the agreement management of designated medical institutions There are two documents involved: the model service agreement for designated medical institutions of basic medical insurance of Jiangsu Province (for Trial Implementation) and the model service agreement for designated retail pharmacies of basic medical insurance of Jiangsu Province (for Trial Implementation) According to the service agreement document of the designated drugstore, if the designated drugstore violates the law, it will be liable for breach of contract The details are as follows: (Note: A is the medical insurance agency, B is the retail drugstore) First, if Party B breaches the contract but does not cause any loss to the medical insurance fund, Party A may make an appointment with Party B and make rectification within a time limit 1 The drug purchase fee is abnormal; 2 Failing to implement management measures in accordance with the requirements of this Agreement; 3 Other violations of the medical insurance policy and the terms of this Agreement are minor Second, in case of any of the following circumstances of breach of contract by Party B, Party A may require Party B to rectify within a time limit, suspend the appropriation, refuse to pay the illegal fees, order Party B to pay the liquidated damages and suspend the agreement according to the seriousness of the circumstances, and recover the paid illegal fees: 1 Failing to perform the provisions of this agreement other than those listed in articles 27 and 29; 2 Engaging in commercial advertising and promotion activities in the name of designated medical insurance companies to induce consumption; 3 Other cases that cause the medical insurance fund to pay in violation of regulations or violate the agreement are serious Third, in case of any of the following Breach of contract by Party B, Party A shall recover the paid illegal fees and terminate the agreement: 1 The following behaviors specified in the notice on strengthening the management of medical insurance agreement to ensure the safety of the Fund (medical insurance Ban Fa [2018] No 21) occur, and the circumstances are serious: (1) Forging false certificates or colluding with the insured to exchange cash to defraud the fund; (2) Providing fee settlement for non designated retail pharmacies or other institutions; (3) Applying for medical insurance settlement of items beyond the scope of the medical insurance catalog according to the items in the catalog; (4) The agreement has been suspended for 3 times in total within the validity period of the agreement, or the agreement has not been rectified according to the time limit or the rectification is not in place; (5) The pharmaceutical trading license or business license has been revoked; (6) Refusing, obstructing or not cooperating with the agency to carry out necessary supervision and inspection; (7) Other breach of contract with serious consequences or significant impact 2 The following behaviors occurred in the notice on printing and distributing (Medical Insurance Office [2018] No 22) issued by the general office of the Ministry of finance of the office of the State Medical Security Bureau, and the circumstances are serious: (1) Stealing and brushing the identity certificate of medical insurance, obtaining cash for the insured or purchasing non-medical items such as nutrition and health care products, cosmetics and daily necessities; (2) Defrauding the medical security fund for the insured by exchanging drugs, consumables, articles, etc; (3) Providing credit card bookkeeping services for non designated medical institutions; (4) Making false invoices or providing false invoices for the insured; (5) Other fraudulent behaviors of designated retail pharmacies and their staff 3 It fails to meet the basic conditions of designated retail drugstores after inspection or evaluation and fails to rectify within the time limit Fourth, in case of Party B's division or merger, the business entity after the division or merger shall bear the liability for breach of contract before the division or merger In case of any breach before the change of Party B's equity or the change of its legal representative, enterprise name or business address, the business entity after the change or change shall bear the liability for breach of contract.