Definition standard of medical insurance fraud

Definition standard of medical insurance fraud

I. Background introduction

Medical insurance is an important social security system, which aims to provide medical and health protection for the public. However, some criminals will use the medical insurance system to cheat in order to obtain improper reimbursement of medical expenses. This behavior not only violates the security and stability of the medical insurance fund, but also harms the interests of other insured persons. Therefore, it is of great significance to clarify the definition standard of medical insurance fraud for combating medical insurance fraud.

Second, the problem.

There are several forms of medical insurance fraud: fictitious medical expenses, forged medical certificates, fraudulent use of other people's medical insurance cards, etc. These behaviors not only violate the original design intention of the medical insurance system, but also bring huge losses to the medical insurance fund. However, due to the complexity and diversity of medical insurance fraud, how to define medical insurance fraud has become a difficult problem.

Third, answer questions.

Fictitious medical expenses. Refers to the act of defrauding the medical insurance fund for reimbursement by fabricating or forging medical expense documents. For example, items not covered by medical insurance will be included in the scope of medical insurance reimbursement, or expenses that have been reimbursed will be reimbursed again.

Forge a medical certificate. Refers to the act of forging medical documents such as doctor's diagnosis certificate and hospitalization certificate to defraud the medical insurance fund for reimbursement.

Fraudulent use of someone else's medical insurance card. Refers to the act of fraudulently using other people's medical insurance cards for medical treatment and reimbursement to defraud the medical insurance fund.

Other forms of medical insurance fraud. For example, medical insurance fraud is carried out by tampering with medical records and altering medical expense receipts.

To sum up:

Medical insurance fraud is a serious illegal act, which not only violates the security and stability of medical insurance fund, but also harms the interests of other insured persons. Therefore, the scope and standards of medical insurance fraud should be clearly defined to combat and prevent the occurrence of medical insurance fraud. At the same time, we should strengthen medical insurance supervision, raise public awareness of medical insurance fraud, and safeguard the fairness and justice of the medical insurance system.

Legal basis:

Article 30 of the Criminal Law of People's Republic of China (PRC) stipulates that defrauding pension, medical care, work injury, unemployment, maternity and other social insurance benefits or other social security benefits by fraud, forgery of certification materials or other means belongs to the crime of fraud as stipulated in Article 266 of the Criminal Law.