Illegal use of medical insurance funds refers to the behavior of designated medical insurance units, insured persons, non-insured persons and other units and individuals who resort to fraud, forge certification materials or other means to obtain medical insurance benefits or defraud the basic medical insurance fund expenditures in the use of basic medical insurance funds. The illegal operation of medical insurance card refers to the illegal operation and provision of illegal services by designated medical institutions and retail pharmacies for their own interests: the insured can buy daily necessities, even rice noodles, oil and salt, cigarettes, dry batteries, cosmetics, gold and silver jewelry and so on. In the non-drug area of pharmacies, in addition to using the medical insurance card to swipe the card in designated retail pharmacies to buy health food with Shi Jian brand and disinfection products approved by the health department.

Legal basis: Article 2 of People's Republic of China (PRC) Social Insurance Law.

The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.