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Medical services provided to citizens free of charge under compulsory medical insurance actually cost a lot of money.
How much each patient costs the budget will become known thanks to the individual information system.
In accordance with the instruction of the President of the Russian Federation and on the basis of FFOMS order No. 108 dated July 28, 2014, from January 1, 2015, each patient will be able to find out how much budget money was spent on him.
Every year the budget allocates funds for the so-called "free" treatment of citizens under the compulsory medical insurance policy.
Every year the amount is indexed: in 2013, the state allocated about 9 thousand rubles for the treatment of one person, in 2014 - more than 10 thousand rubles, and in 2015 - more than 12 thousand rubles.
In the subjects of the federation, these amounts may increase at the expense of the regional budget. Thanks to the principle of health insurance, which can be expressed as: "The rich will pay for the treatment of the poor, the healthy - the sick", - people can receive medical care free of charge.
It was decided to convey to citizens the real amount of treatment costs in the form of a certificate or an extract: seeing a specialist, conducting diagnostic procedures, providing emergency care, outpatient treatment and round-the-clock observation in a hospital have their own cost.
The document contains a list of services provided with an indication of their price. Information for the patient is provided free of charge. Only desire is required of him receive a receipt or refuse it.
In most cases, a person does not realize that provided free of charge under compulsory health insurance may be expensive. And the state at this time spends huge sums to help its citizens.
Not only is it expensive high-tech help.
It is likely that after several years of successful operation of the information program, patients will be able to receive tax deduction based on the amounts indicated in the certificate.
By the beginning of the year, a new patient information program had been tested in a number of regions of Russia. Since September 1, 2014, a pilot project has been launched in seven subjects of the federation: Bryansk, Moscow, Nizhny Novgorod, Novgorod, Tula regions, the Republic of Tatarstan and Krasnodar Territory.
Some subjects of the Russian Federation have joined the project on their own initiative. Since the beginning of 2015 information on the cost of treatment should be available to all patients in any region of Russia.
Even before the introduction of the new information system in the Krasnodar Territory, on the initiative of local authorities, patients received information about the cost of treatment. Since 2008, the procedure for issuing certificates is here completely automated.
Some regions that tested the pilot project did not stop at the proposed procedure and went further: in the Bryansk region, for example, they began to actively develop the use of electronic medical records. In the personal account, the patient can see the list and cost of the procedures performed. Electronic help does not require paper and copying costs, it cannot be lost.
The undoubted advantage of such information is transparency of spending for the treatment of each individual patient and the possibility of independent control of the quality of the medical care provided.
If violations are discovered, the citizen may complain to a medical insurance company, which will always find a way to influence the clinic or hospital.
To provide feedback and explain the functioning of the program, a prerequisite is the presence representatives of the insurance organization in medical institutionsso that people who do not own a computer can get the information they need.
Another fraudulent scheme has become widespread on the Internet. This time, the attackers are trying to cash in on people's ignorance of how the compulsory medical insurance system works. We will tell you how not to part with your own money in an attempt to get nonexistent.
It all starts with the fact that through spam mailing by email, social networks, instant messengers and advertising in applications, potential victims are invited to go to the website of a non-existent organization - Single center for compensation for insured events (also called Center for compensation for unused medical services) - to check the compulsory health insurance policy (CHI) for "Payments for unused medical and other services"... They are supposedly relied on to residents of Russia and neighboring countries on the basis of a non-existent document - "Agreements on social compensation" No. 367 RK / 2017 dated May 11, 2017
After filling out the document verification form, each site visitor is promised six-figure payments (in the amount of more than 100 thousand rubles) based on data from the database of the non-existent "Unified platform of insurers", to gain access to which you need to pay for the service "Access to databases of insurance compensation" (usually a flat fee is offered at 195-250 rubles).
If the victim of the fraudsters agrees to pay for a non-existent service, they go to the website of the payment system that only accepts money. After writing off the amount offered for payment, nothing happens - it's a scam!
After the first payment, the gullible person is also asked to pay for other non-existent services at a higher rate (for checking personal data, for a security pin-code, for an encrypted security key, etc.) until the victim runs out of money or herself will not suspect deception). As a result, only scammers are left with a profit.
Attention
An identical scheme is used by a new scam that announced itself in April 2019, which promises to citizens return of pension savings... To be more convincing, scammers fake website pages well-known TV channels and large news agencies, where fake news about relying payments are posted. They highlight fictitious situations, for example, about non-state pension funds, which allegedly fraudulently appropriated the pension savings of many people, and the President of the Russian Federation "Instructed to deal with NPFs and pay all funds to citizens"... All links from such pseudo news pages lead to cybercriminals' sites that represent a non-existent National Department of Returns of Pension Savingsthrough which the return of hidden pension savings will allegedly be carried out. Of course, gullible users will not receive any money, but they can easily part with their own, since all this is divorce!
In the overwhelming majority of variants of scams, scammers use the notoriously proven scheme of deception on the Internet on the topic "Get the money you owe from the state, which they hide from you"... Unfortunately, the topic of “hidden payments” is still in great demand among citizens of Russia and the CIS countries due to the general distrust of government bodies and various social institutions, especially among the older generation. Earlier, in a similar way, another scam acquired a rampant scale - insurance payments under SNILS, which stopped its distribution only after official departments (in particular, the Pension Fund of Russia - PFR) reacted to it.
In the next version of the scam, it is proposed to receive "free cheese" on behalf of a certain "Unified Center for Compensation for Insured Events" (abbreviated as ETSKSS or EKTsSS, but this does not matter, because such an organization does not exist and the name may change), allegedly providing services through its website visitors to search for and receive non-existent "unpaid insurance claims" under compulsory medical insurance (CHI) policies through closed databases of insurance companies that do not advertise the possibility of receiving compensation for "hundreds of millions of rubles" by ordinary citizens.
Attention
It is necessary to understand that this whole story - one big deceptionand no money really exists. The site of the Center for Compensation for Unused Medical Services exists for the sole purpose of fraudulently taking over the money of gullible citizens. This is a fraud!
To be more convincing, the scammers refer to non-existent normative document, on the basis of which the possibility of obtaining fabulous payments is supposedly "Agreement on social compensation" No. 367 RK / 2017 of 05/11/2017 (in earlier versions of the scam, the same invented decree of the Government of the Russian Federation No. 5123-64pp of 01/19/2018 was indicated).
As the scammers assure, compensation for the specified document is due to site visitors for "Unpaid insured events", payment for which is allegedly provided for by the health insurance policy ( in fact it is a hoax - no payments under the compulsory medical insurance policy are provided!) and which are not issued by citizens due to the complexity of the procedure and lack of time. Nevertheless, the money for these insured events is allegedly "allocated from the budget", remains in accounts with insurance companies and can be claimed by citizens within 3 years after their accrual. It is suggested to do this through the scam website.
Attention
Also, to increase persuasiveness, the site provides numerous fictional reviews on behalf of the people who allegedly received the proposed compensation (although there is no direct opportunity to publish a comment on the site). This is done in order to further confuse and persuade the future victim to deceive.
Statements about the impossibility of receiving insurance payments under the MHI policy have already been published on the official websites of a number of territorial offices of the Mandatory Medical Insurance Fund (MHIF). For example, the branch of the MHIF of the Yamalo-Nenets Autonomous Okrug in the publication dated 02.12.2018 under the characteristic name "OMC is not for sale!" spoke with exposing a fraudulent scheme... In fact, attackers simply take advantage of the ignorance of ordinary citizens about the principles of the compulsory health insurance system in Russia, which completely excludes the possibility of citizens receiving any insurance payments and compensations under the compulsory medical insurance policy!
The fact is that the money entering the CHI system is distributed only for medical organizationsproviding free medical services! This money is actually used to provide free medical care to the population, to purchase medicines and consumables, salaries of medical workers, hospitalization of patients, economic activities, etc.
The compulsory medical insurance system does not provide for any monetary payments and compensation to citizens who applied or did not seek medical help. And there is no such thing as “allocated, but unspent (unclaimed) money” - all funds from the MHIF are sent only to medical institutions (polyclinics and hospitals) for the services actually rendered to the population within the framework of state free medicine!That is, in no way to receive "unused medical services" in the form of monetary compensation the law does not provide! If the patient did not seek medical help, then the state did not allocate money for his free treatment and the medical organization did not receive money for services within the compulsory medical insurance system that were not provided. This money simply remains unallocated in the CHI Fund, and no one can get them!
You should also pay attention to the following two important circumstances:
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Tax officials often question the reality of the service. AT clause 5 of Article 38 of the Tax Code of the Russian Federation it says: “A service for tax purposes is an activity, the results of which have no material expression, are realized and consumed in the course of this activity ”. Therefore, sometimes it becomes very problematic to prove the reality of the provided service ...
Situation: LLC "Petrushka" ordered cleaning services from a cleaning company. For a couple of months until a cleaning lady is hired in the state. How can you prove to the tax authorities that Glasha's cleaning lady washed floors, windows, dusted and took out the trash every day? Take pictures of Glasha while providing cleaning services? Or, for greater safety, Glasha must provide a daily report on the number of floors washed, square meters of dust and garbage bags taken out. To assess the effectiveness of labor and identify whether the quality of the service meets the stated price? It may be absurd, but all means are good in proving the reality of services ...
The company claimed VAT for a deduction for consulting services, but was refused by the tax authorities. Employees of the fiscal service suspected the formality of the transactions. And such conclusions were supported by "reasonable" evidence:
However, the company insisted on the validity and reality of the consulting services provided:
However, the court found the tax authorities' arguments more convincing:
Therefore, based on RF Armed Forces definitions No. 308-KG16-14980 dated 15.11.2016 proved economically unjustified and unreasonable to claim VAT for consulting services.
I turned to the lawyers of Turov and Partners with the question: “How to prove the reality of services / works? After all, if a product can be touched, counted, photographed, then it is almost impossible to touch a service or work ... ”And you can find fault, if you wish, with anything ...
Ramazan Chimaev, lawyer and tax consultant for Turov and Partners:
To recognize the interdependence of persons, the influence that may be exerted due to the participation of one person in the capital of other persons, in accordance with an agreement concluded between them, or if there is another opportunity for one person to determine decisions taken by other persons, is taken into account. In this case, such influence is taken into account regardless of whether it can be provided by one person directly and independently or jointly with its interdependent persons, recognized as such in accordance with this article. "
AT clause 2 of Article 105.1 of the Tax Code of the Russian Federation specific examples of interdependence are given, but the thing is that in p. 7 it is written that the court has the right to recognize persons as interdependent for any other circumstances.
In accordance with By the definition of the Constitutional Court of the Russian Federation of June 4, 2007 No. 320-O-P tax legislation does not use the concept of economic expediency and does not regulate the procedure and conditions for conducting financial and economic activities, and therefore the justification of expenses that reduce the income received for tax purposes cannot be assessed in terms of their expediency, rationality, efficiency or the result obtained. By virtue of the principle of freedom of economic activity (Article 8, Part 1, of the Constitution of the Russian Federation), the taxpayer carries out it independently at his own peril and risk and has the right to independently and individually assess its effectiveness and expediency.
Based on the Letter of the Ministry of Finance of the Russian Federation of June 19, 2015 No. 03-01-18 / 35527 "On the verification of the completeness of the calculation and payment of taxes in connection with transactions between related parties"
In accordance with clause 1 of article 105.17 of the Tax Code of the Russian Federation, verification of the completeness of the calculation and payment of taxes in connection with transactions between related parties is carried out federal executive body, authorized for control and supervision in the field of taxes and fees (hereinafter - the Federal Tax Service of Russia).
At the same time, transactions that are not recognized as controlled in accordance with paragraph 4 of Art. 105.14 Tax Code, as well as transactions for which the volume of income does not exceed those established in article 105.14 of the Tax Code of the Russian Federation the sum criteria cannot be the subject of tax control in order to check the compliance of prices with market prices, both as part of the check of the completeness of the calculation and payment of taxes carried out by the Federal Tax Service of Russia, and as part of field and office tax audits.
As for the acts of acceptance and delivery of services rendered, then for the correct accounting of expenses, an act of services rendered (work performed) is a very important document. The fact is that if the company has provided production services, the act is required. Without it, expenses cannot be confirmed. It follows directly from clause 2 of article 272 of the Tax Code of the Russian Federation... But, even if we are talking about oral consultation or debt collection services from counterparties, one contract will not be enough. And in this case, in order to avoid claims from the inspectors, it is necessary to acquire an act on the services rendered ( Letter of the Ministry of Finance of Russia dated July 30, 2009 No. 03-03-06 / 1/503).
As a general rule, when taking into account the costs of services rendered, the primary documentation should reflect exactly which services / works were performed. Services can be detailed either in the Act of Services Rendered, or in an annex to it, drawn up in the form of a Contractor's Report on the work done. Therefore, if only the general name of the service (legal services, accounting services) is indicated in the Acts, then it would be safer and more correct to request from the contractor a Report on the work performed (detailed) and provide it to the inspectors. The report is signed only by the performer.
Under the compulsory medical insurance policy, you can take tests free of charge for the diagnosis and treatment of most diseases. Forcing a patient to pay for tests is in most cases illegal, but in order to avoid unnecessary expenses or return funds for paying for procedures in public clinics, it is necessary to know the legal basis for interaction between medical institutions, their patients and the insurance company.
The procedure for providing citizens with free medical care under compulsory medical insurance policies is regulated by the following regulations:
All citizens of the Russian Federation who have received a compulsory medical insurance policy are guaranteed medical care, both for basic and additional (regional) programs. The main program includes not only the treatment of pathologies established by the doctor, but also the timely detection of such pathologies, as well as preventive measures.
The list of diseases subject to free therapy throughout the Russian Federation is briefly presented in clause 6 of Art. 35 of Law No. 326, and for more details see the List of Section 4 of Resolution No. 1403.
Free of charge tests are prescribed for the following purposes:
For example, a doctor, based on the symptoms described by the patient, suspects a specific pathology, which is often accompanied by another pathology. If tests for the presence of an underlying disease are free, then tests for the presence of an underlying medical condition must also be performed as part of services paid by the insurance company.
The main medical standards according to which the diseases listed in the basic and additional programs are treated can be viewed on the website of the Ministry of Health of the Russian Federation.
Among the main free types of analyzes are the following:
Only expensive tests for suspected rare autoimmune or genetic diseases that occur less frequently than in 0.01% of cases, as well as tests for aesthetic medicine can be paid.
To determine the legality of a doctor's referral for paid tests, you need to find out whether the required analysis is included in the list of services provided under the basic insurance program.
It is important to know that the basic list of medical services provided throughout the country can be supplemented by:
Regional programs are budget subventions to pay for services that are not in the all-Russian list, and which are provided free of charge only in a specific subject of the federation. These services can only be received by patients who are registered in this region and have received an insurance policy from local insurers.
In addition, large employers who pay premiums for their employees can provide additional packages for free examinations.
To check the possibility of passing the analysis prescribed by the doctor for free, you need to perform the following steps:
A list of additional regional services can be viewed on the website of the regional Ministry of Health, and the services provided under insurance from the employer are listed in the annex to the employment agreement.
If the diagnosed disease is in one of the free programs, and the prescribed tests are included in the standard of treatment of this disease determined by the Ministry of Health, then the patient has the right to take this test for free.
At the initial appointment, the patient is often given a referral for tests to a paid clinic under the pretext of the lack of the necessary equipment or reagents in this clinic. It is important to know that only the patient has the right to choose the place of medical services provision. The doctor can only issue a referral for analysis, and the place of delivery and processing of results is determined by the patient.
Getting a referral for free tests is as follows:
If an appeal to the clinic's management did not bring results, and the necessary analysis is included in the list of basic or regional services provided under the compulsory medical insurance policy, then the patient should contact a representative of his insurance company.
You can contact either through the hotline or personally, to the representative office of this insurer in the village. Most insurance companies have special departments whose work is aimed at resolving conflicts between medical institutions and patients.
If, after attempts made, a referral for a free analysis is not received, then you should contact the regional health insurance fund. Such funds monitor the activities of private insurers in the context of respecting the rights of insured patients.
In some cases, the funds spent by the patient for the delivery of free tests can be returned. You can return funds in 2 ways:
If the patient was sent for a paid analysis at the clinic of treatment, then to return the funds, you need to do the following:
The application contains the patient's full name, his registered address and passport details, then you need to state the reasons for the refund, indicate the amount spent and the number of the insurance policy. The reason is to indicate the presence of the submitted analysis in the basic list of services that the owners of the compulsory medical insurance policies can apply for.
To get a refund, you must keep a receipt for payment for services and an agreement on paid services.
If the patient was sent to a private clinic for testing, the money spent is refunded through the insurer that issued the policy. To do this, you need to contact the representative office of the insurance company of the municipality and draw up an application for a refund based on the occurrence of an insured event - the need to pass an analysis from the basic or additional lists.
The transfer of money through the insurance company is usually carried out within 3-8 business days. If the employer pays the contributions for the compulsory medical insurance policy, then the compensation can be transferred through the company's cash desk or to a salary card.
When applying for compensation or when requesting a referral to another health facility, the patient may face a refusal or a severe delay in responding to the appeal. In most cases, the situation can be resolved by a call to the specialists of the insurance company that issued the policy, or a complaint to the regional CHI fund.
If the prescribed tests are included in the basic list and are an expensive procedure, then the patient has the right to demand the provision of this service free of charge through the judicial authorities. It is important to bear in mind that a referral for tests to another locality or a paid clinic can be issued only under the following circumstances:
The physician must inform the patient about a free equivalent of any medical service provided. Often, patients are deceived by giving a referral for paid tests with the promise of subsequent compensation, to which the patient will not be eligible due to personal refusal from the free service.
To avoid such a deception, you need to carefully review the contract offered for signature when passing paid tests for the presence of a clause on the refusal of a free service. In the presence of this item, the money spent can be returned only by a court decision.
If the patient refuses to issue a contract and a check when providing a paid service, you must refuse to pay and file a complaint with the head physician and the insurance company, since these actions of the personnel are illegal.
Holders of compulsory medical insurance policies can take most of the tests in state clinics free of charge. To exercise your rights, you should look for the assigned analysis in the list of free services and, if necessary, require a referral to another medical facility, and in order to return the money spent, it is important to keep a copy of the contract and a receipt. Most difficult situations are resolved by contacting representatives of the insurance company.
Consulting, informational, legal, audit services, marketing research are always thoroughly checked by the tax authorities. How to prove the reality of the provision of such services by the performer, their necessity for the customer, and even convince the inspectors that the price corresponds to the market price?
Services should not be confused with works. Unlike the latter, the former have no material expression, they are realized and consumed in the process of their provision. The results of work, on the contrary, can be used to meet the needs of both organizations and citizens, which means they have material expression. This is precisely the difficulty of confirming the costs of services, their economic feasibility and feasibility. We have to documentarily prove that they were carried out to generate income in the framework of entrepreneurial activity. Inspectors often believe that the services were not provided or were provided in a smaller volume, that their price was too high and the taxpayer did not need them at all, since the company employs specialists performing similar duties.
To solve the problem of terminology, already in the contract it is necessary to write "services", not "work", "provision of services", and not "performance of work", "act on the provision of services", and not "act of acceptance and transfer of work performed", etc. .d.
The contract is one of the important documents confirming the company's costs, therefore it is necessary to clearly define the subject and list of services in it. You need to be especially careful when drawing up a contract for marketing research, because the subject of such research can be the consumer properties of the products manufactured by the customer, the forecast of demand for it and the market situation in a particular area. In the contract for the provision of information or consulting services, it is necessary to list the duties of the contractor in terms of the actions he performs and indicate the activities that he must carry out. It is advisable to provide ways of consulting the customer. So, such a service can be carried out orally by phone, in the office of the contractor or customer, in writing on the letterhead of the organization, by e-mail, in the form of training or seminars. If the consultant will involve outside specialists, this must also be specified in the contract, but, as a rule, the contractor provides services personally. If consultation on complex issues is expected, it is necessary to fix the condition for the provision of services by specialists of a certain level. These can be qualification certificates or related education. Upon completion of the provision of services, the parties must sign an act or report. Here the opinions of experts were divided: it is necessary to sign either an act or a report, or both. I would recommend the latter, especially if the service is expensive, while in the contract it is necessary to indicate that the result of the provision of services will be a report of the contractor, and after its provision the parties sign an act. Undoubtedly, it all depends on the type of service, when the presence of a report is simply vital for the customer.
To date, no unified forms of either the act or the report have been approved. Therefore, these papers are drawn up in any form. The act indicates the name of the services, the period during which they were provided, their cost. The act is signed by the contractor and the customer, while it can be indicated that the parties have no mutual claims to the volume, quality and timing. The act must be approached with all responsibility, because if you do not specify the name and list of services and their cost, then the costs of such services cannot be recognized in tax accounting. Although some arbitration courts, in the absence of this information in the act, recognize other documents that reflect such information. In addition, in the act, it is necessary to make a reference to the contract under which the services are provided. Thus, this document is necessary to confirm the fact of the provision of services and to determine the period of recognition of expenses for payment of services when calculating income tax.
If the list of services is long enough and the organization does not have the opportunity to fully and in detail set out in the act, then it is necessary to draw up a report.
The preparation of this document is optional, but its presence will serve as a justification for the customer for the costs incurred. When providing some consulting services, it is necessary to prepare a report. In addition, the contractor in this document indicates detailed information about the services provided, makes recommendations to the customer and draws certain conclusions on the subject of the study - all this is of practical importance for conducting business.
What else can be reflected in the report? Depending on the subject of the contract, ask the contractor to indicate the sources of information, possible risks both when using or not using the described recommendations, and when developing various documents. In any case, do not forget that the preparation of the report must be provided for in the contract for the provision of services, otherwise the customer will not be able to demand this paper from the contractor, since it is not a primary document, and the legislation does not contain requirements for its storage.
In accordance with the conclusions of the arbitration courts, the tax authorities are not entitled to require a report to confirm the costs incurred by the customer. But if there is no act, and only a report is available, then you can take into account the costs of paying for services if the following conditions are met:
The preparation of the report is provided for by the contract;
The report indicates the type, volume, methods, period and cost of the provision of services;
It must be drawn up and contain all the mandatory details provided for by the legislation on accounting.
The auditors often do not believe in the reality of the services and demand to present their result and justify it. Even with careful paperwork, tax inspectors refuse to recognize expenses. To prevent this from happening, I recommend that you familiarize yourself with the reasons for such refusals. The arguments are as follows: the absence of a positive economic effect from the use of services, the presence in the staff of the organization of employees performing the same functions as the consultant, the simultaneous provision of similar services by several performers, overpriced relative to market prices, the customer's lack of activity during the period of service provision, etc. ...
What can the taxpayer resist? The Constitutional Court of the Russian Federation indicated that tax legislation does not use the concept of economic expediency and does not regulate the procedure and conditions for conducting financial and economic activities, the organization itself decides what expenses it can carry out to ensure this activity. The main thing is that expenses should be aimed at generating income.
In order not to duplicate the functions of company employees and consultants, it is necessary to correctly draw up job descriptions or regulations on the work of the unit where the specialists serve, which the inspectors can refer to.
If the services are provided by several performers, then the courts are again on the side of the taxpayer, since the current legislation does not limit the right to receive consulting and information services, and the presence of a contractual relationship with one performer does not prevent the company from attracting other specialists to provide similar services.
In the absence of grounds for controlling the cost of services, the tax authorities are not entitled to check the correctness of the application of prices under contracts for the provision of consulting and other similar services and to question these prices. Until proven otherwise, it is assumed that the price quoted by the parties to the transaction is in line with market prices. The tax authorities can check the correctness of the application of prices for transactions only in cases specified in the legislation.
As for consulting services rendered orally, the legislation does not contain requirements for documenting the text of the services received. To confirm the reality of oral consultations, an agreement and an act are sufficient, in which it is necessary to list the services provided, indicate their cost and information about the time spent by the consultant on their preparation.
Subscriber services cause a lot of controversy. It happens that in any month the services were not provided, because there was no need for them. How to be? Can the subscription fee for this month be taken into account when calculating income tax? A controversial point. Both the Finance Ministry and some courts believe that it is possible. Certain tax authorities and other courts, on the contrary, are convinced that if the taxpayer did not receive services in some period, then the subscription fee is not an economically justified expense.