Fraudulent insurance is to defraud medical insurance funds, which is a problem of collusion between hospitals and patients to defraud medical insurance expenses. For example: illegal charging, replacement of project sets, and decomposition of hospitalization; Altering medical documents, brushing social security cards to prescribe drugs, and being unqualified for posts; Fictitious medical records, embezzling medical insurance funds; The insured defrauds the medical insurance fund by forging bills and repeatedly prescribing drugs with multiple social security cards. If the social insurance benefits are defrauded by fraud, forged certification materials or other means, which does not constitute a crime, the social insurance administrative department shall order it to return the defrauded social insurance benefits and impose a fine of not less than two times but not more than five times the amount defrauded; If the amount is relatively large, he shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention, and shall also be fined not less than 10,000 yuan but not more than 100,000 yuan; If the amount is huge or there are other serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than five years but not more than ten years, and shall also be fined not less than 20,000 yuan but not more than 200,000 yuan; If the amount is especially huge or there are other especially serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 10 years, and shall also be fined not less than 20,000 yuan but not more than 200,000 yuan, or his property shall be confiscated.

Legal basis:

Article 87 of the Social Insurance Law of People's Republic of China (PRC), if social insurance agencies, medical institutions, pharmaceutical trading units and other social insurance service institutions defraud social insurance fund expenditures by fraud, forgery of certification materials or other means, the social insurance administrative department shall order them to return the defrauded social insurance money and impose a fine of not less than two times but not more than five 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. Accordingly, if a medical institution defrauds the basic medical insurance fund by means of false treatment items and treatment expenses, it shall bear the following legal responsibilities:

First, the administrative department of social insurance ordered it to return the defrauded basic medical insurance premium.

Second, the social insurance administrative department will impose an administrative penalty of more than two times and less than five times the amount defrauded.

The third is to terminate the service agreement.