Research On The Administrative Law Governance Of Social Medical Insurance Frau

The loss of social medical security funds due to fraud is a hot social issue.Compared to general fraudulent behavior,social medical insurance fraudulent behavior has its unique characteristics,such as strong professionalism,high concealment,and multiple links involved,making it difficult to govern.Therefore,a deeper legal review is needed to objectively evaluate the constraints faced by the governance of social medical insurance fraud.Through attention and reflection on relevant social practices,the governance difficulties faced by social medical insurance are mainly manifested in two aspects: firstly,the legislation on social medical insurance is still lacking,and the supply of legitimacy control legislation is insufficient;The second issue is that the law enforcement mechanism has not been straightened out,and there are many situations related to unclear rights and responsibilities,non-standard law enforcement procedures,and improper law enforcement efforts.Therefore,while updating regulatory concepts,it is necessary to draw on advanced experience from outside the region to achieve normative transmission interaction,differential governance in law enforcement,and systematic coupling in effectiveness.In terms of legislation,it is timely to consider improving the legal status,formulate a special law on social medical insurance anti fraud,set strict disciplinary measures in the special legislation,increase the cost of violations and crimes,further refine and improve relevant legislation,formulate the Implementation Rules or issue relevant legislative interpretation and judicial interpretation,and continue to improve the social medical insurance regulatory legislation.In terms of law enforcement,clarify the rights and responsibilities of relevant entities,collaborate with multiple departments in law enforcement,and strengthen the crackdown efforts;Strengthen pre administrative guidance,flexible law enforcement,promote the construction of standardized medical insurance administrative law enforcement,and increase the intensity of punishment after major events.Correspondingly,it is necessary to strengthen the construction of relevant supporting systems,fully implement the medical information disclosure system,and reduce the concealment of illegal and irregular behaviors;Introduce social forces to participate in supervision,leverage the effectiveness of internal and external supervision,and form a comprehensive cooperative supervision mechanism;Enhance the business capabilities of law enforcement personnel and jointly maintain the security of medical insurance funds.