As a kind of social insurance, medical insurance comes from a basic right of citizens stipulated in our constitution, that is, the right to material help. The purpose of establishing a medical insurance system by the state is to make people affordable for medical treatment, medicine and health. However, some people are eyeing the illegal activities of fraudulent insurance in this field.
Medical insurance fraud has always been an illegal act prohibited by legal norms. In the early stage of China's social insurance development, medical insurance was one of them, so medical insurance fraud was included in social insurance fraud.
Social security agencies, medical institutions, pharmaceutical business units and other social security service institutions defraud social security fund expenditures or individuals defraud social security benefits by means of fraud or forged certification materials, and the social security administrative department shall order them to return the defrauded social security benefits and impose a fine of more than 2 times and less than 5 times the amount defrauded; If it belongs to a social security service institution, the service agreement shall be terminated; If the directly responsible person in charge and other directly responsible personnel are qualified, their qualifications shall be revoked according to law. According to the provisions of Article 94, those who violate the above-mentioned laws and regulations and constitute a crime shall be investigated for criminal responsibility according to law.
In addition to social security agencies, medical institutions, pharmaceutical business units and other social security service institutions and insured individuals, Article 27 of the Regulations on Labor Security Supervision also stipulates the legal liability of employers for defrauding social insurance. If the employer conceals the total wages or the number of employees when reporting the amount of social insurance premiums that should be paid, the administrative department of labor security shall order it to make corrections and impose a fine of not less than 0 times but not more than 3 times the total wages. Cheating social security benefits or defrauding social security fund expenditures, the administrative department of labor security shall order it to be returned, and impose a fine of not less than 0 times but not more than 3 times the amount defrauded; If a crime is constituted, criminal responsibility shall be investigated according to law.
For the criminal responsibility of defrauding social insurance, defrauding social insurance benefits such as pension, medical care, work injury, unemployment and maternity or other social security benefits by fraud, forged certification materials or other means belongs to the act of defrauding public and private property as stipulated in Article 266 of the Criminal Law of our country. According to the law, whoever defrauds public or private property in a relatively large amount shall be sentenced to fixed-term imprisonment of not more than three years, criminal detention or public surveillance, and shall also or only be fined; If the amount is huge or there are other serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 3 years 10 years and fined; If the amount is especially huge or there are other particularly serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 10 or life imprisonment, and shall also be fined or confiscated.
legal ground
People's Republic of China (PRC) social insurance law
Article 87 Where social insurance agencies, medical institutions, pharmaceutical trading entities and other social insurance service institutions defraud social insurance fund expenditures by means of fraud or forgery of certification materials, the social insurance administrative department shall order them to return the defrauded social insurance money and impose a fine of more than 2 times but less than 5 times the amount defrauded; If it belongs to a social insurance service institution, the service agreement shall be terminated; If the directly responsible person in charge and other directly responsible personnel are qualified, their qualifications shall be revoked according to law.
Article 88 Anyone who defrauds social insurance benefits by fraud, forgery of certification materials or other means shall be ordered by the social insurance administrative department to return the defrauded social insurance benefits, and shall be fined at least two times but not more than five times the amount defrauded.
Eighty-ninth, social insurance agencies and their staff.