Case analysis of hospital financial revenue and expenditure audit
Abstract: With the strengthening of the audit work of audit institutions, more and more hospital financial revenue and expenditure are included in the focus of auditing. In recent years, audits of hospitals have exposed many violations of regulations and disciplines in financial revenue and expenditure.
Keywords: financial revenue and expenditure; audit; case; analysis
As the audit work of audit institutions strengthens, hospital financial revenue and expenditure are increasingly included in the focus of auditing. In recent years, audits of hospitals have exposed many violations of regulations and disciplines in financial revenue and expenditure. In order to establish and improve the hospital's internal accounting management system, fully implement accounting laws, regulations and systems, and ensure the orderly conduct of accounting work, the author uses the form of case analysis on the collected "Audit Reports" and "Audit Decision Letters" of audit institutions , pointed out the seriousness and harm of irregular financial revenue and expenditure, and proposed improvement measures, which will help promote the legal concept of accounting personnel, strengthen the management of financial revenue and expenditure, and protect the safety and integrity of hospital property.
1 Hospital income lacks integrity. Hospital income is the main compensation channel for medical consumption. It fully reflects the overall picture of hospital income. It not only directly reflects the labor value created by medical staff and the implementation of financial subsidy policies, but also ensures financial results. accuracy. However, incomplete and incomplete hospital revenue accounts are somewhat common in hospitals.
Case 1: The sponsorship fee of 414,000 yuan collected by a hospital when it held the opening ceremony of its second department in 2002 was included in the accounting of "other payables". The 799,000 yuan clinical observation fee for medical equipment and drug clinical observation fee collected in 2005 is also accounted for in the "other payables" account.
Case 2: A hospital affiliated with the College of Traditional Chinese Medicine recorded the RMB 260,000 research fee for outstanding TCM talents allocated by the Provincial Department of Health and the RMB 410,000 house rental fee received into the "other payables" account.
Case 3: Between 2004 and 2005, a tertiary hospital collected 4.259 million yuan in organ transplant fees, internship fees, and continuing education and training fees, which were hidden in the "other payables" account.
Case 4: The Second Affiliated Hospital of a certain medical school transferred 213,000 yuan in revenue from medical records and manuals to the "other payables" account.
Case 5: A provincial people's hospital included the funds for key clinical medicine specialty projects allocated by the provincial health department into the "other payables" account.
For the above violations, the audit department ordered them to reverse or adjust relevant accounting accounts in accordance with the "Regulations on the Implementation of Auditing of the People's Republic of China". Analysis: The above violations are caused by confusing the boundaries between income and debt in accounting. Hospital income refers to the business income obtained by the hospital from carrying out business activities, non-repayable funds obtained from other activities, and subsidy funds obtained from the financial and competent departments [1]. Liabilities refer to debts borne by the hospital that can be measured in currency and need to be repaid with assets or services. The standard for drawing a clear distinction between the two is to determine whether the source of funds is non-repayable or needs to be repaid. Any funds obtained by the hospital from other activities and funds allocated by the financial and administrative departments that do not need to be returned by the hospital in installments should be accounted for in the revenue account; any funds invested by external units that need to be returned by the hospital on schedule must be reflected in the liability account. Because the audit agency is auditing the hospital's financial revenue and expenditure of the previous year or previous years, the accounts and financial final accounts have been sealed, and the current year's accounts cannot be adjusted. According to the current "Hospital Accounting System", they can be adjusted to the "Public Fund" account. Improvement measures: Relevant hospital accountants are required to study the "Hospital Accounting System" in depth, carefully grasp the concept and scope of hospital income, and conduct standardized accounting.
2 Cost distortion caused by confusion in the scope of cost expenditures The economic essence of costs determines that costs play a very important role in economic management. Cost is a measure to compensate for the cost of medical activities, an important factor in setting the price of medical services, and a prerequisite for competition in the medical market. Carrying out cost accounting correctly and providing real and useful cost information are the basic tasks of cost accounting. In the audit practice, two completely different cost-distorting accounting methods were discovered - hospitals with poor economic efficiency, in order to create performance for the director, do everything possible to exclude expenses that should be included in the cost, resulting in inflated costs. , profits are inflated; hospitals with good economic benefits are worried that excessive balances at the end of the year will affect the assessment of financial subsidy targets for the coming year, so they use various means to expand the scope of cost expenditures, resulting in inflated costs and inflated profits.
Case 6: A hospital purchased 4.429 million yuan of heating coal last year and it was listed on the current account, but the cost was not allocated in a timely manner. The investment was 4.010 million yuan in the technology company to which it belongs. The company has been disbanded and its investment cannot be recovered. It has been listed in "other receivables" for a long time. Analysis: In accordance with the provisions of the "Regulations on the Implementation of the Budget Law of the People's Republic of China", the government finance department, departments and units should review and verify the annual budget revenue, expenditure figures and current accounts at the end of each year, and make The reconciliation of final accounts should be done well, and the income and expenses of this year should not be transferred to the income and expenses of the next year [2]. The cost of the hospital purchasing heating coal in winter should be accounted for in the "prepaid expenses" account, and the cost should be allocated monthly during the heating period. Funds invested in companies that have gone bankrupt should be reported to the Ministry of Health and the Ministry of Finance for write-off based on an investigation of the situation.
Transferring expenditures to the next year or not recording expenditures for a long time is obviously a violation of the "Regulations on the Implementation of the Budget Law of the People's Republic of China".
Case 7: Two hospitals directly included the purchased fixed assets of 4.038 million yuan and 1.538 million yuan with a unit price of less than 100,000 yuan respectively in the "medical expenditure" account. Analysis: This accounting method violates the provisions of the "Hospital Accounting System". According to regulations, any purchase cost that constitutes a fixed asset standard must be paid out of the special fund for purchase and repair, otherwise it will result in duplication of expenses. Because when purchasing fixed assets, the cost is included once, and when the purchase fund is withdrawn at the end of the month, the cost is included again. The same economic matter is included in the cost twice, which will result in an inflated increase in costs. Hospital accounting personnel must correctly divide the boundaries between normal expenditures and special fund expenditures, and correctly grasp the sources of funds for the purchase of fixed assets.
Case 8: A hospital accrued in 2005 the heating expenses settled in 2004 ① Huazhong University of Science and Technology School of Economics Wuhan 43,007.497 million yuan, withheld the pension insurance fund of 1.400 million yuan in 2004, and actually paid 423,000 yuan Yuan, the difference is not offset against expenses. Analysis: There may be errors between accrued expenses and actual expenses, but after an accounting event occurs, it must be included in the cost according to the actual expenses. The excess must be offset against expenditures, and the insufficient part must be made up for accrued expenses, otherwise costs will be incurred. virtual increase or decrease. It seems important to clean up "accrued expenses" at the end of each year.
Case 9: For ventilators and other equipment purchased by a hospital, an additional repair and purchase fund of 3.642 million yuan was provided based on one year of use. Analysis: According to the "Hospital Accounting System", medical equipment is withdrawn from repair and purchase funds based on the age method; the Ministry of Finance and the Ministry of Health stipulate that the useful life of medical equipment is between 5 and 10 years. The hospital withdraws all the value of its medical equipment within one year, which is a rapid depreciation method that will inevitably increase the medical costs for that year. Accounting personnel should be proficient in the prescribed service life of medical equipment and calculate the accurate deposit rate of the repair and purchase fund. The state gradually transfers funds for the purchase of medical equipment to the cost of medical services as it wears out to prevent abnormally high and abnormally low medical costs.
Case 10: A hospital withdrew a bad debt reserve of RMB 56,000 at the end of 2005. Analysis: According to the principle of accounting prudence, the hospital sets up the "bad debt provision" account. The essence of the bad debt provision system is to predict the possible bad debt losses and withdraw them from the cost in advance to prepare for the write-off of bad debt losses. Currently, hospitals have large medical arrears, part of which cannot be recovered. If bad debt reserves are not withdrawn as required, once bad debts occur, there will be no reliable source of funds to write them off.
3 Non-independent accounting is an institutional revenue and expenditure that is not included in the budget management. The revenue and expenditure of a non-independent accounting branch run by a hospital is part of the hospital’s financial revenue and expenditure and must be included in budget management. Financial reports should be prepared in conjunction with the hospital. The purpose of this provision in the "Hospital Financial System" is to reflect the concepts of "big revenue" and "big expenditure" and comprehensively reflect the overall picture of the hospital's revenue and expenditure. In financial revenue and expenditure management activities, some hospitals only calculate the financial revenue and expenditure of their own hospital, but do not include the revenue and expenditure of non-independent accounting branches organized by the hospital into the hospital's unified financial accounting and unified management, and consolidate and prepare financial reports, which makes the hospital Financial balance loses integrity.
Case 11: A hospital affiliated to a medical university recorded an income of 1.194 million yuan and an expenditure of 998,000 yuan from the affiliated "Ophthalmology Magazine" in the "other payables" account, and the medical income obtained by the affiliated chronic hospital was 3.650 million yuan. Yuan is not included in the financial accounts for unified management.
Case 12: A hospital affiliated with traditional Chinese medicine in a province had an income of 1.730 million yuan and an expenditure of 2.180 million yuan from its three outpatient departments, but did not prepare financial reports on a consolidated basis with the hospital.
Case 13: A large hospital suffered a cumulative loss of 3.033 million yuan to its logistics support service department that did not have legal person status and was not included in the unified financial accounting; the affiliated cancer research institute had an income of 1.260 million yuan and an expenditure of 830,000 yuan. Accounted for in the "Other accounts payable" account.
Case 14: A hospital generated 74,000 yuan in parking revenue from the parking lot, which was managed by the Security Department, and part of it was used directly to pay temporary workers. Analysis: The hospital does not include the income and expenditure of affiliated institutions with non-independent accounting into unified financial accounting. This is mainly due to insufficient understanding of the concept and meaning of "non-independent accounting" institutions. It unilaterally believes that as long as affiliated institutions establish separate accounts in banks and set up account books for accounting Accounting is an independent accounting unit.
In fact, independent accounting is a key criterion to determine whether a hospital branch has legal person status. The "General Principles of the People's Republic of China and Civil Law" stipulates that a legal person is an organization that has the capacity for civil rights and civil conduct, and independently enjoys civil rights and assumes civil obligations in accordance with the law. A legal person shall meet the following conditions: (1) be established in accordance with the law; (2) have necessary property or funds; (3) have its own name, organization and location; (4) be able to bear civil liabilities independently. Therefore, most of the hospital's branches do not have legal person status and are non-independent accounting institutions and must be included in the hospital's budget management.
4 Underpayment of social insurance premiums and taxes Social insurance is a national compulsory insurance, and taxes are one of the main sources of national finance. Paying units and paying individuals should pay social insurance premiums and taxes in full accordingly. In audit practice, omitting or underpaying social insurance funds and personal income tax are common illegal behaviors and seriously infringe on national interests.
Case 15: A hospital underpaid 220,000 yuan to the medical insurance fund, of which the unit underpaid 170,000 yuan and the individual employees underpaid 50,000 yuan. Case 16: A hospital underpaid 179,000 yuan in social security funds, including 76,000 yuan in medical insurance funds, 65,000 yuan in unemployment funds, and 38,000 yuan in pension insurance funds. Case 17: The "International Journal of Pediatrics" affiliated to a certain hospital failed to pay RMB 19,000 in business tax, surcharges and value-added tax. Case 18: A hospital failed to withhold and pay personal income tax of RMB 10,000, and another hospital underpaid personal income tax of RMB 38,000. Case 19: A hospital listed 288,000 yuan in lunch and night meal subsidies for employees in its normal funds, but did not withhold personal income tax of 28,000 yuan. Case 20: A tertiary hospital underpaid social insurance premiums by 10 million yuan a year. The "Audit Decision" of the relevant departments requires these medical institutions to pay social insurance premiums and taxes within a time limit in accordance with the "Tax Collection and Management Law of the People's Republic of China" and the "Interim Regulations on the Collection and Payment of Social Insurance Premiums".
Analysis: Hospitals underpay social security funds, mostly due to errors in total salary calculations. Because the base for payment of basic medical insurance for employees, pension insurance and unemployment insurance is based on total wages, the undercounting of total wages leads to underpayment of social security funds. There are two manifestations of errors in the calculation of total wages: First, hospitals with poor economic efficiency calculate total wages based on actual wages instead of due wages. Second, when calculating total wages, only basic wages are considered, while bonuses, subsidies and allowances are ignored. There are two factors in the two situations: First, the total salary is deliberately concealed to achieve the purpose of underpaying social security benefits. Second, accounting personnel lack understanding of the policy on the composition of total wages, resulting in incomplete composition of total wages. The solution is: hospitals should establish an overall concept and effectively safeguard national interests, and accounting personnel should carefully study the "Regulations on the Composition of Total Wages" issued by the National Bureau of Statistics on January 1, 1990 to ensure the accuracy of total wage calculations. 5 Capital construction and the purchase of medical equipment and drugs have not fulfilled legal procedures. In terms of financial management, capital construction must strictly implement the business processes of bidding, bidding and controlling the scale of construction projects; the purchase of medical equipment and drugs must comply with government procurement and drug centralized bidding and procurement business procedures. . Illegal procedures for economic matters are also a disciplinary violation, and the hospital must bear certain legal responsibilities.
Case 21: A hospital invested 2.3 million yuan in expanding the interventional ward without inviting or bidding, and chose its own engineering team for construction without authorization.
Case 22: The planned infrastructure construction scale for the expansion of the surgical ward building of a hospital is 11 849 m2, the actual construction scale is 13 563 m2, and the over-scale construction is 1 714 m2.
Case 23: A hospital expanded its outpatient building. The approved budget was 98.76 million yuan, but the actual investment completed was 150.75 million yuan, exceeding the planned investment by 52%. Analysis: The implementation of bidding and bidding management for construction projects will help shorten the construction period, ensure project quality, reduce project costs, and achieve investment benefits. In compliance with the provisions of the "Tendering and Bidding Law of the People's Republic of China", all provinces (municipalities and autonomous regions) have formulated "Construction Project Bidding Regulations", which generally stipulate that the total investment is 2 million yuan or the construction area is more than 2,000m2. Construction projects such as expansion, renovation and technical renovation must be issued through tenders. If a project that requires bidding is broken into parts or otherwise avoids being ordered to undergo bidding, a fine of 2% to 5% of the project cost may be imposed. In order to control the blind expansion of the scale of infrastructure projects, the State Council and the National Development and Reform Commission have repeatedly issued requirements to control the scale of fixed asset investment. Construction must be carried out in strict accordance with the approved investment budget and must not exceed [3]. If the design estimate is exceeded due to subjective reasons, the responsible department and the principal person in charge of the construction unit shall be held accountable. The national project approval department also stipulates that when the actual investment in a construction project is expected to exceed the budget by 10%, the construction unit must re-prepare a feasibility study report and apply to the project approval department for an additional total project budget estimate. Hospitals must strictly implement capital construction investment management regulations. If they touch "high-voltage wires", the directly responsible person in charge of the unit and other directly responsible personnel must be punished in accordance with the law.
References
[1] Ministry of Finance of the People's Republic of China, Ministry of Health of the People's Republic of China. Hospital Accounting System [M]. Beijing: Finance Publishing House Society, 1998: 15.
[2] Order of the President of the People's Republic of China. Budget Law of the People's Republic of China [Z]. 1994.
[3 ] State Council. Several Provisions on Controlling the Scale of Fixed Asset Investment [Z].1986.