Accordingly, to enhance health insurance review, health insurance fund management under law and ensure health insurance participants’ benefits, VSS requires province,city social security office to strictly implement the following contents:

Region social security office actively cooperates with health facilities to organize and implement health insurance examination and treatment, legal regulations on medical examination and treatment and regulations on health insurance; clarify the legal responsibility of medical examination and treatment facilities regarding the information in medical records, figures, and data used to request to pay  health insurance medical examination and treatment premiums; the health facility takes responsibility under regulation and accuracy of the cost statement on medical examination and treatment and the data submitted for quarterly payment.

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Local social security offices are requied to strictly implement the health insurance review procedures and directives issued by the VSS including the conclusions of VSS leader regarding medical review, medical examination and treatment cost control; responsibility for the results related to all medical review activities;  strengthening the development and implementation of thematic assessments in the locality, ensuring quality and effectiveness; Carry out the advance payments, settlements, draw balance on HI-covered medical examination and treatment costs in accordance with the provisions of the Law on Health Insurance.

Health insurance examination and treatment facilities are required to develop appropriate regulations and criteria for inpatient admission in accordance with professional requirements, the number of hospital beds, available equipment, and human resources as stipulated under Directive No. 25/CT-BYT dated December 21, 2020 by the Ministry of Health on continuing to strengthen the management and improve the quality of health insurance examination and treatment as a basis for medical review. Strict implementation of Directive No. 10/CT-BYT dated September 9, 2019 by the Ministry of Health on enhancing the prevention and control of abuse and misuse of the health insurance fund is also required.

Especially, VSS strengthens the control of health insurance medical examination and treatment costs, to prevent abuse and profiteer of the health insurance fund; firmly refuse to pay for proposed medical examination and treatment premiums without following legal regulations, professional guidelines, or the treatment protocols issued by the Ministry of Health; transfer case files to the competent authorities for verification, clarification, and handling in accordance with the law in cases showing signs of legal violations, abuse, or profiteering of the health insurance fund."

Health insurance medical examination and treatment database is regularly utilized to analyze, assess, and clearly identify each medical examination and treatment facility with unusual or unreasonable increases in HI medical examination and treatment premiums; provide monthly notifications for examination and treatment facilities to conduct self-inspection and adjustments; monitor the results of these adjustments and report to the Provincial People's Committee for direction to the Department of Health to coordinate with the provincial Social Seucrity office in organizing inspections at medical examination and treatment facilities showing signs of abnormal or unadjusted expenditure increases;  closely coordinate with the Department of Health and HI medical examination and treatment facilities to promptly resolve arising issues within their authority and in accordance with legal regulations.

VSS requests units and local social insurance offices continue to tighten discipline and administrative order, clearly assign responsibilities regarding individuals, tasks, accountability, and outcomes for managerial officials, civil servants, and employees involved in HI medical review. Any negative activities in task performance are strictly prohibited. It is necessary to regularly provide professional training for officials and civil servants realated to HI medical review to improve the quality of their work.