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TIlN TOI DAO
H I E MXA Hdi CHO MOI NGUDI LAO DONG VA BAO HIEM V It TDAN DAN
WiM 1IS&Hiffl w&mm am 0 » B luAi sao mu xa m, eao mu v IE
Hoat ddng thanh, kiem tra da co hi|u qua trong viec ngan ch3n va xi!r ly lcip thdi nhQng sai pham trong quan ly, to chUc thUc hien chinh sach phap luat ve BHXH va BHYT, gop phan quan ly quy cd hieu qua;
die biet la trong cdng tac tliu nop, cliij siif dung lao ddng da y thUc dUdc trach nhifm tham gia bao hiem theo luat djnh de dam bao quyen lpi, che dd cho ngudi lao dpng, gdp phan thuc hien tot chfnh sach an sinh xa hdi.
CAC tiOAT D 6 N G C I J A He THONG KIEM TFRA BHXH
Trudc day chinh sach BHXH va BHYT dUdc quy dmh tai Dieu le tam thdi ban hanh kem theo cac Ivighj dmh, ddng thdi cung chua cd van ban quy dmh cu the viec xO phat cac hanh vi vi pham trong cac ITnti vUc nay vi the hieu qua hoat ddng thanh tra, kiem tra cdn rat han ctie; Sau khi 2 Luat tren cd hieu lUc thi hanh (Luat BHXH cd hieu lUc tO 1/1/2007 va Luat BHYT cd hieu lUc to 1/7/2009), Chinh phu da ban hanh Nghi dmh 135/2007/NO-CP quy dmh ve xO phat trong ITnh vuc BHXH va Thdng tU lien tich sd 03/2008/TTLT-BLOTBXH-BTC- NHNN hudng da'n thu tuc budc trich tien to tai khoan tien gOi cua ngUdi sO dung lao ddng de nop tien BHXH chUa ddng, cham ddng va tien lai phat sinh. Song trong qua trinh td chOc thoc hien da bdc Id nhieu bat cap va iian che, dac biet la tinh kha thi cua nhflng quy dmh tai Thdng tU lien tich sd 03/2008/TTLT, de khac phuc ngay 13/8/2010 Chinh phu da ban hanh Nghi dmh sd 86/2010/ND-CP thay the Nghi dmh sd 135/2007/NO-CP ngay 16/8/2007 quy dmh ve xO phat vi pham hanh chinh trong ITnh vUc BHXH. Rieng nghj dmh xO phat cac
-^ Ths. TRflN Dtfc LONG
Pho Tntdng ban Kiem tra Bdo hiem Xd hgi Viet Nam
Xet xd Cdng tyAnjin va Cong ty Do chai Qud'c teLucl<y ng BHXH tai Toa an Nhan dan quan Binh Tan (TP.HCI[/i).
hanh vi vi pham hanh chinh trong ITnh vUc BHYT dang trong qua trinh soan thao, lay y kie'n tham gia cua cac bd nganh trinh Chinh phu trong thdi gian tdi.
Hoat dong thanh tra, kiem tra thuc hien Luat BHXH
Ve viec thuc hien che' dp thu nop, nhieu doanh nghiep vdi nhieu ly do da cd tinh vi pham, trdn tranh trach nhiem tham gia, qua thanh tra, kie'm tra phat hien hang nghin lao ddng thudc dien bat budc chUa dang ky tham gia BHXH hoac tham gia khdng dung mOc quy dmh, da lap bien ban xac dmh truy thu hang chuc ty ddng (nam 2007 la 2,5 ty ddng; nam 2008 la 3,9 ty ddng; nam 2009 la 3,2 ty ddng); phat hien va thu hdi nd dong hang tram ty ddng (nam 2007 la 203,3 ty ddng; nam 2008 la 304,5 ty ddng; nam 2009 la 401,8 ty ddng).
Qua tdng hpp, danh gia toan
nganh, nam 2008 sd np BHXH tO 1 de'n dudi 3 thang la 1.320 ty ddng, chie'm 57,7% tdng sd np; tO 3 thang trd len la 966 ty ddng, chie'm 43,5%
tdng sd np. Nam 2009 sd nd tO 1 den dudi 3 thang la 1.564 ty ddng, chie'm 74,7% tdng sd np; tO 3 thang trd len la 529 ty ddng, chie'm 25,3%
tdng sd np. Sau thang dau nam 2010, sd np to 1 de'n dudi 3 thang la 2.360 ty ddng, chie'm 40% tdng so np; to 3 thang trd len la 2.005 ty ddng, chie'm 34% tong sd np; dac biet, sd ddn v| np dpng tren 12 thang tinh de'n thang 7 nam 2010 la 5.325 ddn vj vdi sd np la 652,6 ty ddng, chie'm 15,4% td'ng so np.
Nhflng ddn vj cd sd np dpng cao chu yeu tap trung d cac tinh, thanh phd Idn va d cac khu cdng nghiep.
TO thuc trang dd, BHXH Viet Nam chi dao BiHXH cac dja phUdng tich cUc ddn dd'c thu nop va phdi hdp vdi cac nganh hflu quan lap hd
TAD r u i IAD B O N G VIA XA H O I - <;0 391 - kV Q THAMG 9/Q010
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TIEN TOn BAO HIEM XA HOI CHO MOI NGUdi LAO DONG VA BAD HIEM Y TE TOAN DAN
sd tien hanh khdi kien ra tea dd'i vdi cac ddn v| vi pham, cu the: nam 2008 khdi kien 9 ddn vj, tea thu ly xet xO 5 ddn v|, 4 ddn v| da ndp trudc khi tea thu ly; nam 2009 khdi kien 116 ddn vj, tea da hoa giai va xet xO 98 ddn v|, cdn lai 18 ddn vj dang thu ly chd xet xO; 6 thang dau nam 2010 khdi kien 39 ddn vj, tea an da hda giai va xet xO 7 ddn v|, cdn 32 ddn v| dang thu ly chd xet xO. Viec sO dung bien phap khdi kien da cd tac ddng tich cUc, mdt sd ddn Vj da y thOc dope trach ntiiem trong viec tham gia BHXH song cdn rat han che, chu ye'u mdi thUc hien khdi kien tai Thanh phd i-ld Chi Minh va mdt sd it tinh, thanh phd cd tap trung cac khu cdng nghiep.
Qua thanh, kiem tra viec thflc hien quan ly chi tra cac che' dp da phat tiien va thu hdi chi hudng sai cac che dp ngan han (d'm dau, thai san, nghi dudng sOc) cua cac ddn vj sfl dung lao ddng va xet hudng cac che dp hang thang khdng dung ddi tupng, sai quy dmh hoac chi hudng qua thdi gian qui dmh hang tram trieu ddng mdi nam (nam 2007 la 394,9 trieu ddng; nam 2008 la 403,4 trieu ddng; nam 2009 la 411,6 trieu ddng).
Hoat dpng thanh tra, kiem tra thuc hien Luat BHYT
Nam 2009 va 6 thang dau nam 2010, BHXH Viet Nam da trUc tie'p kie'm tra 15 cd sd kham chfla benh cd ky hpp ddng kham chfla benh BHYT tai 10 dja phUdng, kiem tra dot xuat theo chuyen de viec quan ly va thanh quyet toan quy tai 4 tinh la Binh Dmh, Lao Cai, Kien Giang, Ha Tinh. BiHXH cac dja phUdng phdi hpp vdi^ cac nganh chOc nang tie'n hanh kiem tra tai 684 cd sd y te (nam 2009 la 557 cd sd, 6 thang dau nam 2010 la 127 ddn vj). Ket qua cho thay viec vUpt quy cao d mdt seed sd kham chfla benh ngoai nhflng tdn tai, sai sdt trong cdng tac nghiep vu giam dmh, thd'ng ke chi phi, mdt phan khdng nhd do lam dung cac djch vu y te, djch vu ky thuat cao (trong xet nghiem va chan doan...), lam dung thud'c va vat tu y te' tieu liao va ca viec lap chOng tO, hd sd benh an khd'ng de' thanh toan
vdi cd quan BHXH. Oa lap bien ban xO ly thu hdi hean tra quy kham chfla benh la 30,486 ty ddng, trong dd BHXH Viet Nam trOc tie'p xO ly la 23,114 ty ddng.
NhOng vUdng mac, ton tai - Cac van ban hudng da'n trien khai thflc hien luat dupc ban hanh chua k|p thdi, cd nhflng die'm chUa rd rang da'n de'n viec lOng tung trong td chflc thuc hien va treng hoat ddng thanh tra, l<ie'm tra khd phan dmh de xO ly.
- Ngh! dmh 135/ND-CP ngay 16/8/2007 quy dmh ve xO phat cac hanh vi vi pham hanh chinh trong ITnh vUc BHXH qui dmh mOc xO phat va mflc lai suat cham ddng thap so vdi mflc lai tien vay khdng du tinh ran de nen nhieu doanh nghiep chap nhan ndp phat de' chie'm dung quy BHXii; ddng thdi quy dmh tai Thdng tu lien tjch sd 03 ngay 18/2/2008 cua Bd Lae ddng - ThUdng binh va xa hdi, Bd Tai chinh va Ngan hang Nha nUdc tren thflc te thuc hien gap nhieu vudng mac, chua ngan hang nao thflc hien trich tien to tai khoan tien gfli cua cac doanh nghiep de' ddng BHXH theo quy djnh, song viec sfla dd'i cac van ban tren cdn cham.
- Chua cd he thd'ng thanh tra chuyen nganh ve BHXH va BHYT, dpi ngu can bd kie'm tra cua BHXH Viet Nam thie'u on dmh va cO ban chua dupc dao tao nghiep vu ve thanh tra, kiem tra da han che khdng nhd de'n viec to chOc thflc hien hoat ddng kiem tra cua BHXH Viet Nam, dac biet la viec kie'm tra dd'i vdi cac cd sd kham chfla benh cd ky hpp ddng BHYT
- Cd che quan ly quy kham chfla benh BHYT tai cac cd sd y te hien nay chfla khoa hpc, cac cd sd kham chfla benh chfla thay dupc trach nhiem cua minh trong quan ly va sO dung quy.
- BHXH mdt so dja phUdng da thflc hien khdi kien ddi vdi cac ddn v| np dpng tien bao hiem keo dai, song day la mdt loai an mdi (chfla cd dpi ngu chanh an va luat sfl chuyen trach) nen cd quan Tea an (ke ca cap tinh va cap quan, huyen)
cdn cd nhflng quan die'm khac nhau trong thu ly va xet xO.
GIA! PHAP VA KIEN NGHI - Kjp thdi bd sung va hoan thien cac van ban hUdng dan thUc hien chinh sach BHXH, BHYT (Bao gdm ca nhflng ndi dung bat cap, khdng cdn phfl hpp cua Luat) va dac biet la cac van ban quy dmh treng thanh tra, kiem tra va xO ly sai pham cho phu hpp vdi dieu kien kinh te'ya nang Iflc quan ly hien nay Can day nhanh tien dp thflc hien BHYT toan dan, ddi mdi phfldng thflc thanh toan chi phi kham chOa benh nham nang cao trach nhiem quan ly va sO dung quy kham chfla benh cua cac cd sd y te'.
- Tang^ cUdng cdng tac tuyen truyen, phd bie'n chinh sach phap luat ve BHXH va BHYT giup mpi ngfldi dan tham gia hie'u va thay ro quyen Ipi va trach nhiem cua minh de cung phoi hpp trong viec kiem tra, giam sat cac to chflc, cd quan thflc thi chinh sach va cung la tu bao ve quyen Ipi cua chinh minh.
- Tren cd sd chUdng trinh va quy che phdi hpp gifla BHXH Viet fvlam vdi Bd Lao ddng - Thfldng binh va xa iidi, Bd Y te', BHXH cac tinh, thanh phd can tranh thu sfl chi dao cua cap uy, chinh quyen, xay dflng mdi quan tie phd'i hpp vdi cac nganh hflu quan tai dia phfldng trong viec kie'm tra, giam sat td chflc thflc hien chinh sach phap luat ve bao hie'm. Tang cfldng cac cudc thanh tra, kie'm tra lien nganh nham kjp thdi dieu chinh va thao gd khd khan cho cac ddn v\ sfl dung lao ddng, cac cd sd y te, ddng tiidi phat hien va xO ly k|p thdi cac vi pham phap luat.
- Giao cho BHXH Viet Nam chflc nang thanh tra, xay dflng he thd'ng to chflc thanh tra chuyen nganh tO trung Udng de'n cac dja phUdng cung vdi viec cung cd va kien toan dpi ngu can bd cd day du piia'm chat va nang lUc, hieu biet sau ve chinh sach, cd trinh dp nghiep vu trong quan ly tai chinh, quan ly quy va nghiep vu y te. Trong xet xfl, de nghj bo sung cho Tea an cac cap ddi ngu can bd chuyen nganh ve BHXH va BHYt •