I fell and left. Medical insurance needs to be investigated. If the trauma caused by a third party lies about his own reasons and can be reimbursed for medical insurance when he is admitted to the hospital, it is considered as maliciously defrauding the medical insurance fund, and there are corresponding punishment measures, which can seriously constitute a criminal offence. The medical expenses that should be borne by the third party according to law shall be paid in advance by the basic medical insurance fund if the third party is unable to pay or cannot determine the third party. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

How to investigate the medical insurance for falls at home?

For the medical insurance survey of home falls, you can find people around you to prove it, or you can find a village Committee to prove it. The medical expenses incurred by the insured in the agreed medical institutions that meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards shall be paid from the basic medical insurance fund in accordance with state regulations. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation. Accidental falls cannot be reimbursed. According to national regulations, the medical expenses caused by accidental injuries are within the reimbursement scope of residents' medical insurance and urban workers' medical insurance.

To sum up, yes, if the trauma caused by a third party lies about the reimbursement of medical insurance for its own reasons when it is admitted to hospital, it will be considered as maliciously defrauding the medical insurance fund, and there are corresponding punishment measures, which can seriously constitute a criminal offence. The medical expenses that should be borne by the third party according to law shall be paid in advance by the basic medical insurance fund if the third party is unable to pay or cannot determine the third party.

Legal basis:

Article 30 of People's Republic of China (PRC) Social Insurance Law

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

The medical expenses that should be borne by the third party according to law shall be paid in advance by the basic medical insurance fund if the third party is unable to pay or cannot determine the third party. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.