What are the patterns in medical insurance fraud cases? Who are the main persons involved in fraud crimes?

For most people, paying for medical insurance is a very necessary personal behavior. Medical insurance is the most basic social security system that can ensure the basic medical service needs of employees. However, some criminals take advantage of it. There is a gap in medical insurance to defraud huge sums of insurance money. Today, Hualu will take everyone to look at what are the crimes of defrauding medical insurance? 1. The concept of medical insurance

Medical insurance generally refers to social medical insurance, which is a social security system created to compensate employees for property losses caused by disease risks. After the employer company and individuals make contributions, a medical insurance fund is created. After the insured person gets sick and incurs medical expenses, the medical insurance agency will provide a certain amount of financial compensation.

The establishment and implementation of the social medical insurance system gathers the economic power of units and social groups, coupled with the support of relevant departments, so that sick social groups can receive necessary material supply assistance from individuals and reduce the cost of medical treatment. Reduce cost pressure and prevent sick social groups from becoming impoverished due to illness. 2. What are the crimes of fraudulently claiming medical insurance?

Allowing or inducing non-payers of social insurance to be hospitalized in the name of insured persons. The medical expenses that must be paid by the individual themselves and paid for by the social insurance are applied to the medical insurance fund for collection. Even if you are hospitalized in a hanging bed, you will be able to pay social security as an outpatient to be admitted and hospitalized in person. Excessive medical treatment or provision of unnecessary health services through repeated appointment registration for social security payment, repeated or unqualified treatment, dissolved hospitalization, etc. Violating the scope or type of medicine required by medical insurance, taking excessive amounts of medicine, repeating medicine, using specially restricted medicines in violation of regulations, or dissolving or changing prescriptions to prepare liquids for individuals paying social insurance. Consolidate the expenses incurred by non-designated hospitals to the expenses of designated medical insurance hospitals for settlement with medical insurance and social security agencies. Helping the person who pays social security to defraud the medical insurance personal account stock fund or pooled fund.

Illegal charging behaviors such as arbitrarily raising tariff standards, increasing project charges, dissolving charging standards, repeating charges, and continuously expanding charging standards. Engaging in malpractice for personal gain and defrauding medical insurance funds or personal account funds through false reports and false transmission of data. Selling medicines for non-designated pharmaceutical business enterprises and brushing social security cards on behalf of others. Convert drugs, diagnosis and treatment items, medical materials, diagnosis and treatment public service facilities or daily necessities, health care food ingredients and other expenses outside the scope of medical insurance payment into expenses within the scope of the medical insurance policy, apply for medical insurance liquidation, and defraud medical insurance funds paid.

Counterfeiting or using medical documents such as false medical history, prescriptions, test reports, hospital diagnosis certificates, etc. to defraud medical insurance funds. Use falsely reported medical expense documents for reimbursement. Other violations of relevant provisions of social security lead to losses of medical insurance funds. 3. Relevant criminal issues involved in assessing the crime of insurance fraud

(1) Clear the line between the crime of insurance fraud and non-criminal behavior. The key point is whether the amount of insurance money fraudulently obtained reaches a relatively large amount, but does not exceed a relatively large amount. It can be treated as a general violation of insurance laws, and a relatively large amount constitutes the crime of insurance fraud.

(2) Relevant criminal issues involved in assessing the crime of insurance fraud. Anyone who engages in insurance fraud activities and intentionally causes losses, death, disability, or illness of the beneficiary through actions such as arson, murder, damage, spread of infectious diseases, abuse, abandonment, etc., to defraud the insurance money shall be punished in accordance with the Criminal Law "Article 198, paragraph 2, stipulates that several crimes shall be punished, such as arson and insurance fraud, homicide and insurance fraud, intentional injury and insurance fraud, etc. The above is an act of insurance fraud.