The official dispatch stated that over the past time, social security agencies of provinces have made great efforts in organizing the implementation of the health insurance policy, fulfilling the dual goals of the industry in the context of the complicated developments of the COVID-19 pandemic.

However, according to the notice of inspection and examination conclusions of the competent authority, the report of recommendations of the medical facility covered by health insurance as well as the results of checking and reviewing the database on the health insurance assessment information system shows that there still remains a number of shortcomings, as follows: The advance and payment of medical treatment costs with health insurance between the social insurance agency and the medical facility have not been timely made in accordance with regulations prescribed in Article 32 of the Law on Health Insurance, as there has still been the situation of delay, excess or shortage in advances in medical care expenses.

The signing of the medical care under health insurance contract was not completed on time as prescribed in Decree 146/2018/ND-CP of the Government; The state of statistics and payment of health care costs covered by health insurance is unreasonable, not in accordance with regulations, and overpayment of medical care costs under health insurance still occurs.

Illustrative image (source: internet)

At the same time, the direct assessment at medical facilities has not been regular, leading to the fact that the situation of over-prescribing drugs, technical services, and issuing sick leave certificates to enjoy social insurance, etc., has not been detected. A number of cases were prosecuted by the investigating police agency and prosecuted the accused who are employees of medical facilities for taking advantage of the health insurance fund but the provincial social insurance agency did not promptly detect and report it to the VSS (as in Bac Giang and Yen Bai provinces).

In order to ensure the payment of medical care costs under health insurance in accordance with the provisions of the law, to prevent abuse and profiteering of the health insurance fund, and to use the funding allocated by the Prime Minister economically and efficiently, the VSS requires the directors of the provincial social insurance agencies to direct the professional departments to strictly implement the advance payment of medical care costs under health insurance in accordance with the provisions of Article 32 of the Law on Health Insurance and the guiding documents of the VSS.

Strengthening health insurance assessment, focusing on implementing key tasks in 2021 on health insurance assessment under the direction of VSS in Official Dispatch No. 3868/BHXH-CSYT dated December 7, 2020. To closely combine assessment on the system and directly at medical facilities to promptly detect and prevent abuse and profiteering of health insurance funds.

Illustrative image (source: internet)

To closely coordinate with functional agencies (Inspector, Police) to promptly detect and handle abuses and profiteering of health insurance funds, and also report to the VSS for direction and settlement.

To strengthen responsibility in ensuring the legitimate interests of the participants of health insurance, especially avoiding cases where patients with health insurance have to pay medical expenses within the scope of benefits and entitlements according to regulations. Directors of social security agencies of provinces are also requested to seriously implement and timely report to VSS of difficulties and problems for direction and settlement.