The first illegal fraudulent medical insurance fund accounts for less than 0.2% of the annual medical insurance fund payment and is corrected in time. The administrative department of medical security shall order it to return and impose a fine of less than 2 times the amount defrauded; The relevant responsible departments shall order designated medical institutions to suspend medical services involving the use of medical insurance funds for less than 6 months. The first kind of illegal and fraudulent medical insurance funds account for more than 0.2% and less than 0.5% of the annual medical insurance fund payment. If it is corrected in time, the administrative department of medical security shall order it to return, and impose a fine of more than 2 times and less than 3 times the amount defrauded; Ordering designated medical institutions to suspend medical services involving the use of medical insurance funds by relevant responsible departments for more than 6 months and less than 9 months.

First, how to convict and sentence the hospital for defrauding the medical insurance fund

1, defrauding the medical insurance fund shall be punished as fraud. At present, China has officially defined social security fraud as a criminal offence. The Social Insurance Law stipulates that the crime of defrauding social insurance benefits such as pension, medical care, work injury, unemployment and maternity or other social insurance benefits will be treated as fraud.

2. For the crime of fraud stipulated in Article 266 of the Criminal Law, if the amount is relatively large, he 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.

3. According to the provisions of the Supreme People's Procuratorate and the Ministry of Public Security on the standards for the prosecution of economic crime cases, those who swindle public or private property in an amount of more than 3,000 yuan to 1000 yuan, 30,000 yuan to 1000 yuan and 500,000 yuan are respectively deemed as "a large amount", "a huge amount" and "a particularly huge amount" as stipulated in Article 266 of the Criminal Law. The higher people's courts and people's procuratorates of all provinces, autonomous regions and municipalities directly under the Central Government may, in combination with the economic and social development of the region, jointly study and determine the specific amount standards implemented in the region within the scope of the amount specified in the preceding paragraph, and report them to the Supreme People's Court and the Supreme People's Procuratorate for the record.

II. The following 14 cases belong to medical insurance fraud:

1, allowing or inducing uninsured individuals to be hospitalized in the name of the insured.

2. The medical expenses paid by the insured person at his own expense shall be declared and paid to the medical insurance fund.

3, hanging bed in the hospital or will be able to outpatient treatment of insured individuals admitted to hospital.

4, the insured individuals use repeated registration, repeated or no indication of treatment, decomposition of hospitalization and other means of transitional medical care or provide unnecessary medical services.

5, in violation of the provisions of the scope of medical insurance drugs or drug varieties, excessive use, repeated use, illegal use of drugs with special restrictions, or self decomposition, change the prescription, etc. Dispensing medicines for the insured.

6 expenses incurred by non-designated medical institutions shall be incorporated into the expenses of designated medical institutions and settled with medical insurance agencies.

7, to assist the insured person to bear the medical insurance personal account fund or overall fund.

8. Illegal charging behaviors such as raising charging standards, increasing charging items, decomposing charging items, repeating charging, and expanding charging scope without authorization.

9, fraud, false data, etc. Access to medical insurance funds or personal account funds.

10, selling drugs for non-designated drug business units and swiping social security cards on their behalf.

1 1. Change the expenses of drugs, diagnosis and treatment items, medical materials, medical service facilities or daily necessities, health supplements, etc. beyond the scope of medical insurance payment into expenses within the scope of medical insurance policy, apply for medical insurance settlement, and collect funds to pay.

12, forging or using false medical records, prescriptions, inspection reports, disease diagnosis certificates and other medical documents to defraud the medical insurance fund.

13, using false medical bills for reimbursement.

14, other acts that violate the relevant provisions of social insurance and cause losses to the medical insurance fund.

Legal basis: Regulations on the Supervision and Administration of the Use of Medical Insurance Funds

Article 3 The use of medical insurance funds shall be centered on people's health, and the level of protection shall be commensurate with the level of economic and social development, and the principles of legality, safety, openness and convenience shall be followed.

Article 4 The supervision and management of the use of medical insurance funds shall combine government supervision, social supervision, industry self-discipline and personal integrity.