What should I do after the pharmacy is investigated by the medical insurance bureau?

There are mainly five administrative inspections or administrative penalties for retail pharmacies, and law enforcement will be carried out on the basis of laws, administrative regulations, three plans, ministerial regulations, government regulations and normative documents.

legal ground

First, pharmacies that defraud medical insurance and maternity insurance funds by means of fraud or forgery of certification materials shall be punished according to the following basis:

Article 87 of the Social Insurance Law: If social insurance agencies, medical institutions, pharmaceutical trading units and other social insurance service institutions defraud social insurance funds by fraud, forgery of certification materials or other means, the social insurance administrative department shall order them to return the defrauded social insurance money and impose a fine of not less than two times but not more than five times the amount defrauded.

Article 104 of the Basic Medical Hygiene and Health Promotion Law stipulates that if the basic medical insurance agency, medical institution or pharmaceutical business unit defrauds the basic medical insurance fund by fraud, forgery of certification materials or other means, the competent medical security department of the people's government at or above the county level shall give administrative punishment in accordance with the laws and administrative regulations on social insurance.

Article 25 of the Detailed Rules for the Implementation of the Social Insurance Law of People's Republic of China (PRC): If a medical institution, pharmaceutical trading entity or other social insurance service institution defrauds the social insurance fund by fraud, forgery of certification materials or other means, the social insurance administrative department shall order it to return the defrauded social insurance money and impose a fine of not less than two times but not more than five times the amount defrauded.

Measures for the Administration of Social Insurance Fraud Cases (No.20 166 1 issued by the Ministry of Human Resources and Social Security).

Second, if there are drug price violations in pharmacies, administrative inspections and administrative penalties will be carried out according to the following basis:

Article 33 of the Price Law of People's Republic of China (PRC): The competent price department of the people's government at or above the county level shall supervise and inspect the price activities according to law, and impose administrative penalties on price violations in accordance with the provisions of this Law.

Article 34 When conducting price supervision and inspection, the competent price department of the government may exercise the following functions and powers: (1) Asking the parties or relevant personnel to provide certification materials and other information related to price violations; (2) Inquiring and copying account books, bills, vouchers, documents and other materials related to price violations, and consulting bank materials related to price violations.

Article 35 When accepting the supervision and inspection by the competent price department of the government, business operators shall truthfully provide the account books, bills, vouchers, documents and other materials needed for price supervision and inspection.

Article 2 of the Provisions on Administrative Penalties for Price Violations: The competent price department of the people's government at or above the county level shall supervise and inspect price activities according to law and decide on administrative penalties for price violations.

The Provisions on the Function Allocation, Internal Organization and Staffing of the National Medical Insurance Bureau stipulates that the National Medical Insurance Bureau shall supervise and manage the medical service behavior and medical expenses brought into medical insurance coverage, and investigate and deal with illegal acts in the field of medical insurance according to law.