Strengthening prevention and control of fraud and profiteering from social insurance funds

Recently, in order to limit fraudulent acts and profiteering from social insurance, unemployment insurance and health insurance funds, Vietnam Social Security has issued many documents directing and guiding social insurance agencies of provinces and cities to proactively and resolutely implement solutions to prevent, detect and stop violations of the law on social insurance, unemployment insurance and health insurance.

Many violations have been detected and promptly handled; many issues have been resolved or summarized, reported and proposed to competent authorities for consideration and resolution by Vietnam Social Security. Recently, the Social Security agency and relevant authorities have detected and handled a number of violations in the fields of social insurance, unemployment insurance and health insurance in a number of localities, specifically as follows:

On abuse and profiteering of sickness and maternity funds

Employees take advantage of the Social Insurance Fund by using fake Social Insurance Leave Certificates or those issued by medical examination and treatment facilities that are not in accordance with regulations to pay for Social Insurance benefits. Thereby, medical examination and treatment facilities also take advantage of the Health Insurance Fund by settling medical examination fees, medicine costs, technical services... from the Health Insurance Card of the person who bought the Social Insurance Leave Certificate. Typical cases include the cases at private clinics in Dong Nai (prosecuted); at the Dong Van Ward Health Station, Duy Tien Town, Ha Nam Province (Ha Nam Provincial Police are verifying)...

In addition, in order to take advantage of the social insurance fund, employers request to settle the sick leave, maternity leave, and health recovery benefits for employees who are working with salary, on vacation, unpaid leave, on personal leave, or are being treated for work-related accidents... Or, employers and employees agree to only pay 6 months of social insurance or increase the social insurance contribution level to an unusually high level during the 6 months before giving birth to receive maternity benefits...

Taking advantage of one-time social insurance benefits under authorization

Taking advantage of the urgent need of employees to receive one-time social insurance payment early to cover immediate difficulties, on the other hand, the current regulations on procedures for receiving one-time social insurance are very simple, so some subjects have organized to collect social insurance books of employees through the form of mortgage, authorization (employees owning social insurance books write a document authorizing another person to carry out procedures for receiving one-time social insurance). This is an act of buying and selling social insurance books, not only causing great disadvantages for employees when they only receive 1/3 to 1/2 of the real value of the social insurance book, but in the long term also creates pressure on the social security system.

On abuse and profiteering of social insurance fund

During the period of receiving unemployment benefits, the employee has a job (the employee has signed an official labor contract with the employer) but does not declare to the Job Center. After the period of receiving unemployment benefits expires, the employee files a request for the Social Insurance Agency to pay compulsory social insurance for this period.

On abuse and profiteering of health insurance fund

Medical facility staff use the health insurance card of a relative or take the card code of a health insurance patient who has previously visited the clinic to create documents requesting payment of expenses; collude with brokers to create fake medical records for life insurance participants to both profit from life insurance and health insurance (like the incident that occurred at Thai An General Hospital, Vinh Medical University Hospital, Nghe An).

In addition, there are other forms of abuse and profiteering from the health insurance fund such as: Medical facilities making statistics and paying for technical services not in accordance with regulations; making statistics and proposing payment for more than the actual amount of medicine used; using medicine that is not suitable for the diagnosis; organizing the collection of people with health insurance cards to provide unnecessary medical services, causing waste of the health insurance fund... On the patient side, patients borrow other people's health insurance cards to go to medical examination and treatment or use their health insurance cards to go to medical examination and treatment many times to get medicine to use for purposes other than their own treatment...

Faced with the above situation, in order to promote the prevention and suppression of abuse and profiteering of social insurance, unemployment insurance and health insurance funds, Vietnam Social Security has regularly and proactively grasped the situation and issued documents directing and guiding local social security agencies to strengthen coordination with departments, boards, sectors, especially investigation agencies to promptly detect and handle violations. However, when detecting the above-mentioned acts, the Vietnam Social Security sector has only stopped at the handling direction of recovering or recommending competent authorities to resolve. The solutions implemented by the sector are only temporary, not really having strong enough tools to proactively prevent, deter and deter organizations and individuals from abusing and profiteering.

To contribute to solving this situation, in addition to the efforts of the Vietnam Social Insurance sector, it is necessary to have the attention and direction of the Ministry of Labor - Invalids and Social Affairs, the Ministry of Health and the People's Committees of provinces and centrally run cities in preventing, combating and stopping abuse and profiteering of the Social Insurance, Unemployment Insurance and Health Insurance funds. Accordingly, Vietnam Social Insurance requests the Ministry of Labor - Invalids and Social Affairs to continue to pay attention to and strengthen inspections of units that are late in paying Social Insurance, Unemployment Insurance, Health Insurance, etc.; coordinate with the Social Insurance agency to step up the review and sharing of data to prevent the situation of employees receiving Unemployment Insurance benefits in violation of regulations and to recover the benefits to the Unemployment Insurance fund, etc.

With the Ministry of Health, strengthen direction in the coordination of inspection and examination of the implementation of health insurance medical examination and treatment and payment of health insurance medical examination and treatment costs; promptly handle violations due to health insurance fraud by medical examination and treatment facilities and patients...

With the People's Committees of provinces and cities, direct relevant State management agencies to strengthen inspection and supervision of agencies, units and enterprises in the area in complying with the law on social insurance, unemployment insurance and health insurance; grasp the "health" situation of enterprises to provide timely warnings. At the same time, direct relevant departments, branches and sectors to actively participate and closely coordinate with the provincial Social Insurance agency to promote: propaganda and dissemination of laws on social insurance, unemployment insurance and health insurance; inspect and examine labor-using units in the area, focusing on inspecting and examining units showing signs of violations in collecting and paying, settling benefits of social insurance and unemployment insurance; improve the efficiency and effectiveness of inter-sectoral inspection and examination; monitor, detect and promptly and strictly handle violations of the law on social insurance, unemployment insurance and health insurance to promptly ensure the rights and legitimate interests of participants.