Research On Full Coverage Audit Based On Medical Insurance Fund In City A

Since the reform and opening up in 1978,in order to meet the needs of national medical security,China’s medical insurance system has experienced pilot exploration to comprehensive coverage,and has been continuously reformed and developed to expand the scope and improve the level of security.At present,the development trend of China’s medical security industry is good,the operation trend of medical insurance fund is stable,and the medical security units at all levels across the country actively build the framework of medical security system with Chinese characteristics.However,there are still some problems,such as the improvement of medical insurance treatment,the lack of refinement of medical insurance fund management,and the thorny behavior of fraud and insurance fraud.In order to solve these problems,audit,as a powerful supervision means of medical insurance funds,has always played an important role in promoting the standardized use of funds by medical security institutions at all levels through audit rectification,ensuring the implementation of local medical insurance policies,and recovering the defrauded medical insurance funds to the greatest extent.Therefore,it is of great significance to study how to strengthen the audit supervision of medical insurance fund,strengthen the audit means of medical insurance fund,and improve the audit quality of medical insurance fund,so as to ensure the safe and sustainable development of medical insurance fund and promote the continuous improvement and progress of medical insurance system.On December 1,2020,China launched a full coverage audit of the "basic pension" and "basic medical" insurance funds in 31 provinces,autonomous regions,municipalities directly under the central government and Xinjiang production and Construction Corps.This thesis is based on the full coverage audit of medical insurance fund in city A.the audit work is carried out in strict accordance with policies and regulations,runs through the whole process of fund operation and covers the whole scope of the fund.Firstly,the thesis summarizes the policies and regulations on which this audit action is based and the current operation of medical insurance fund in city a,then introduces the full coverage audit process in detail from the four aspects of fund raising,use,operation management and fraud and insurance fraud,and finally puts forward corresponding suggestions by analyzing the problems existing in the audit process: first,improve the utilization efficiency of audit resources,Make full use of human and material resources;Second,improve the construction of big data audit of medical insurance funds and enrich audit evidence;Third,carry out the performance audit of medical insurance fund to improve the audit quality;Fourth,improve the audit and supervision system of medical insurance fund and give full play to the function of audit and supervision;Fifth,establish and improve relevant laws and regulations and use audit results with high quality and efficiency.The innovations of this thesis are as follows: first,guided by the latest policies related to medical insurance,this thesis discusses the full coverage audit process of medical insurance fund in city a,and considers how audit can better supervise the implementation of various policies and promote the improvement and progress of policies and regulations;Secondly,taking the actual case as the research object,combined with the relevant theoretical literature of medical insurance funds at home and abroad,it has certain practical reference significance to find problems,summarize experience and put forward suggestions from practice.I hope this thesis can enrich and expand the existing contents related to medical insurance fund audit,and make contributions to improving the quality of medical insurance fund audit and promoting the improvement of medical insurance system.