Legal analysis: An individual’s behavior of fraudulently using, forging, altering, or lending medical insurance certificates.
Designated medical institutions and designated retail pharmacies conduct medical insurance settlements for medical expenses that exceed basic medical insurance diagnosis and treatment items, medical service facilities and medication scopes, as well as payment standards.
Designated medical institutions and designated retail pharmacies conduct private online settlements or include expenses incurred by non-designated medical institutions into medical insurance settlements.
Designated retail pharmacies use tonics, health products or other items instead of medicines for medical insurance settlement.
Legal basis: Article 84 of the "Social Insurance Law of the People's Republic of China" If the employer fails to register for social insurance, the social insurance administrative department shall order it to make corrections within a time limit; if it fails to make corrections within the time limit, the employer shall be liable for the social insurance dues.
A fine of not less than one time but not more than three times the amount of the fee shall be imposed, and the person directly in charge and other directly responsible personnel shall be fined not less than RMB 500 but not more than RMB 3,000.
Article 85 If the employer refuses to issue a certificate of termination or rescission of the labor relationship, it shall be handled in accordance with the provisions of the Labor Contract Law of the People's Republic of China.
Article 86 If an employer fails to pay social insurance premiums in full and on time, the social insurance premium collection agency shall order it to pay within a time limit or make up the amount, and a late payment fee of 0.05% will be imposed on a daily basis starting from the date of default;
In case of failure to pay, the relevant administrative department shall impose a fine of not less than one time but not more than three times the amount of the unpaid amount.
Article 87 If social insurance agencies, medical institutions, pharmaceutical business units and other social insurance service institutions defraud social insurance fund expenditures through fraud, forged certification materials or other means, the social insurance administrative department shall order the refund of the fraudulently obtained social insurance funds.
, a fine of not less than two times but not more than five times the amount defrauded shall be imposed; if it belongs to a social insurance service institution, the service agreement shall be terminated; if the person in charge and other directly responsible persons who are directly responsible have professional qualifications, their professional qualifications shall be revoked in accordance with the law.
Article 88 Anyone who defrauds social insurance benefits through fraud, forged certification materials or other means shall be ordered by the social insurance administrative department 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.
Article 89 If a social insurance agency and its staff commit any of the following acts, they shall be ordered to make corrections by the social insurance administrative department; if losses are caused to the social insurance fund, the employer or an individual, they shall be liable for compensation in accordance with the law; those directly responsible
Supervisors and other directly responsible personnel shall be punished in accordance with the law: (1) Failure to perform statutory social insurance duties; (2) Failure to deposit social insurance funds into a special fiscal account; (3) Withholding or refusing to pay social insurance benefits on time
; (4) Loss or tampering with social insurance data such as payment records, social insurance benefits records, and personal rights records; (5) Other behaviors that violate social insurance laws and regulations.