Vietnam: Compilation of penalties for medical examination and treatment using health insurance according to Decree 117/2020/ND-CP

18:40, 09/07/2024

On November 15, 2020, Decree 117/2020/ND-CP came into effect, replacing Decree 176/2013/ND-CP on administrative penalties in the field of healthcare. Decree 117/2020/ND-CP significantly increases the penalties for administrative violations concerning health insurance. LawNet has compiled the penalties for these violations in the table below.

No.	VIOLATION	PENALTY	LEGAL BASIS
1	Failure to pay health insurance for individuals who are required to participate in health insurance	Warning or a fine ranging from 300,000 VND to 500,000 VND	Clause 1 Article 80 Decree 117/2020/ND-CP
2	Failure to pay health insurance for all employees mandatory to participate in health insurance, insufficient payment of health insurance for those required, late payment, or evasion of health insurance payment	A fine ranging from 1,000,000 VND to 40,000,000 VND depending on the number of employees violated	Clause 2 Article 80 Decree 117/2020/ND-CP
3	Insufficient payment of required health insurance	A fine ranging from 1,000,000 VND to 40,000,000 VND depending on the value of the violation	Clause 3 Article 80 Decree 117/2020/ND-CP
4	Misappropriation of health insurance funds.	A fine ranging from 10,000,000 VND to 15,000,000 VND	Clause 4 Article 80 Decree 117/2020/ND-CP
5	Including individuals in the list of health insurance participants against the law but without causing damage to the health insurance fund	A fine ranging from 1,000,000 VND to 2,000,000 VND per health insurance card	Clause 1 Article 81 Decree 117/2020/ND-CP
6	Including individuals in the list of health insurance participants against the law, and have used it for medical examination and treatment causing damage to the health insurance fund	A fine ranging from 2,000,000 VND to 3,000,000 VND per health insurance card
7	Participating in health insurance at an agency or organization against the law but without using the health insurance card for medical examination and treatment	A fine ranging from 1,000,000 VND to 2,000,000 VND per person with a health insurance card	Clause 2 Article 81 Decree 117/2020/ND-CP
8	Participating in health insurance at an agency or organization against the law, and have used the health insurance card for medical examination and treatment	A fine ranging from 2,000,000 VND to 3,000,000 VND per person with a health insurance card
9	Incorrect certification of the contribution rate for health insurance participants	A fine ranging from 1,000,000 VND to 50,000,000 VND depending on the value of the violation	Article 82 Decree 117/2020/ND-CP
10	Preparing and submitting the list for issuing health insurance cards to the participants under management responsibilities later than the stipulated time without causing damage to the participants' benefits	A fine ranging from 500,000 VND to 1,000,000 VND	Clause 1 Article 83 Decree 117/2020/ND-CP
11	Preparing and submitting the list for issuing health insurance cards to the participants under management responsibilities with fewer people than regulated but without causing damage to the participants' benefits
12	Preparing and submitting the list for issuing health insurance cards to the participants under management responsibilities later than the stipulated time causing damage to the participants' benefits	A fine ranging from 1,000,000 VND to 2,000,000 VND for delays under 10 working days as prescribed by law	Clause 2 Article 83 Decree 117/2020/ND-CP
13	A fine ranging from 2,000,000 VND to 3,000,000 VND for delays under 10 working days as prescribed by law
14	Preparing and submitting the list for issuing health insurance cards to the participants under management responsibilities with fewer people than regulated causing damage to the participants' benefits	A fine ranging from 1,000,000 VND to 20,000,000 VND depending on the number of missing people in the list	Clause 3 Article 83 Decree 117/2020/ND-CP
15	Lending or using someone else's health insurance card for medical examination and treatment without causing damage to the health insurance fund	A fine ranging from 1,000,000 VND to 2,000,000 VND	Clause 1 Article 84 Decree 117/2020/ND-CP
16	Lending or using someone else's health insurance card for medical examination and treatment causing damage to the health insurance fund	A fine ranging from 3,000,000 VND to 5,000,000 VND
17	Preparing medical records, prescribing medicines that do not exist or are incorrect for patients	A fine ranging from 200,000 VND to 30,000,000 VND depending on the value of the violation	Clause 1, 2 Article 85 Decree 117/2020/ND-CP
18	Over-prescription or adding medicines, medical materials, technical services, bed costs, and other costs that the patient did not actually use	A fine ranging from 500,000 VND to 70,000,000 VND depending on the value of the violation	Clause 1, 2 Article 86 Decree 117/2020/ND-CP
19	Incomplete provision of prescribed medicines, medical materials, and technical services during medical examination and treatment	A fine ranging from 500,000 VND to 50,000,000 VND depending on the value of the violation	Clause 1, 3 Article 86 Decree 117/2020/ND-CP
20	Violating the scope of benefits entitlement for health insurance participants	A fine ranging from 300,000 VND to 15,000,000 VND depending on the value of the violation	Clause 1, 2 Article 87 Decree 117/2020/ND-CP
21	Incorrect pricing, categorizing, specifying units, or naming technical services in health insurance cost settlement	A fine ranging from 300,000 VND to 50,000,000 VND depending on the value of the violation	Clause 1, 2 Article 88 Decree 117/2020/ND-CP
22	Unilateral termination of health insurance contract for medical examination and treatment in violation of the law	A fine ranging from 1,000,000 VND to 3,000,000 VND	Clause 1 Article 89 Decree 117/2020/ND-CP
23	Signing health insurance contracts for medical examination and treatment with unlawful content
24	Signing health insurance contracts for medical examination and treatment without proper authority as stipulated by law
25	Unilateral termination of health insurance contract for medical examination and treatment causing damage to the rights of health insurance participants, medical facilities, or health insurance fund	A fine ranging from 3,000,000 VND to 40,000,000 VND depending on the value of the violation	Clause 2 Article 89 Decree 117/2020/ND-CP
26	Signing health insurance contracts for medical examination and treatment with unlawful content or without proper authority causing damage to the rights of health insurance participants, medical facilities, and the health insurance fund	A fine ranging from 1,000,000 VND to 40,000,000 VND depending on the value of the violation	Clause 3 Article 89 Decree 117/2020/ND-CP
27	Incorrect determination of entitlement in health insurance medical examination and treatment based on the health insurance card information	A fine ranging from 200,000 VND to 7,000,000 VND depending on the value of the violation	Clause 1, 2 Article 90 Decree 117/2020/ND-CP
28	Report on health insurance implementation not submitted on time or providing inaccurate or incomplete data to the competent state authority without affecting the management, organizing, and policy-making of health insurance	Warning or a fine ranging from 200,000 VND to 500,000 VND	Clause 1 Article 91 Decree 117/2020/ND-CP
29	Report on health insurance implementation not submitted on time or providing inaccurate or incomplete data to the competent state authority affecting the management, organizing, and policy-making of health insurance	A fine ranging from 5,000,000 VND to 10,000,000 VND	Clause 2 Article 91 Decree 117/2020/ND-CP
30	Failure to provide, providing inaccurate or incorrect information about health insurance participants promptly, without affecting the health insurance examination and treatment fund	Warning or a fine ranging from 200,000 VND to 500,000 VND	Clause 1 Article 92 Decree 117/2020/ND-CP
31	Failure to provide, providing inaccurate or incorrect information about health insurance participants promptly causing damage to the health insurance examination and treatment fund	A fine ranging from 1,000,000 VND to 20,000,000 VND depending on the value of the violation	Clause 2 Article 92 Decree 117/2020/ND-CP
32	Failure to provide, providing incomplete, or incorrect information in solving benefits for patients at medical examination and treatment facilities or direct payment for health insurance participants without causing damage to their benefits	Warning or a fine ranging from 200,000 VND to 500,000 VND	Clause 1 Article 93 Decree 117/2020/ND-CP
33	Failure to provide, providing incomplete, or incorrect information in solving benefits for patients at medical examination and treatment facilities or direct payment for health insurance participants causing damage to their benefits	A fine ranging from 1,000,000 VND to 3,000,000 VND	Clause 2 Article 93 Decree 117/2020/ND-CP
34	Submitting the final cost report for medical examination and treatment later than the stipulated time under 5 working days	A fine ranging from 500,000 VND to 1,000,000 VND	Clause 1 Article 94 Decree 117/2020/ND-CP
35	Submitting the final cost report for medical examination and treatment later than the stipulated time from 5 working days to under 20 days	A fine ranging from 3,000,000 VND to 5,000,000 VND	Point a Clause 2 Article 94 Decree 117/2020/ND-CP
36	Submitting the final cost report for medical examination and treatment later than the stipulated time from 20 days or more	A fine ranging from 5,000,000 VND to 7,000,000 VND	Point b Clause 2 Article 94 Decree 117/2020/ND-CP
37	Hindering or causing difficulties in health insurance medical examination and treatment without causing damage to the rights of the health insurance participants, medical facilities	A fine ranging from 500,000 VND to 20,000,000 VND depending on the value of the violation	Clause 1, 2 Article 95 Decree 117/2020/ND-CP
38	Overusing medical services in health insurance medical examination and treatment, including presc, and using excessive medicines, chemicals, medical materials, technical services, and other medical services beyond the maximum or needed levels as stipulated by professional technical regulations causing damage to the rights of health insurance participants, medical facilities, or health insurance fund	A fine ranging from 500,000 VND to 40,000,000 VND depending on the value of the violation	Clause 1, 3 Article 95 Decree 117/2020/ND-CP
39	Failure to register with the social insurance agency the seal sample, signature sample of the practitioner authorized to sign health certificates, and the authorized personnel to sign and seal the medical facility on the certificates	A fine ranging from 1,000,000 VND to 3,000,000 VND	Clause 4 Article 95 Decree 117/2020/ND-CP
40	Failure to connect, synchronize data, create electronic documents on medical examination and treatment as per electronic transaction regulations in the field of health insurance

Duc Thao

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- This translation is generated by OpenAI's GPT-4o model;
- The legal regulations in this article are according to Vietnamese Law;
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