1. Is it fraud to defraud the medical insurance fund?
Fraudulent medical insurance fund is fraud. According to the relevant laws and regulations of our country, defrauding the medical insurance fund does not constitute the crime of contract fraud, but it will constitute the crime of fraud, and the suspects who defraud the medical insurance fund should be investigated for criminal responsibility.
Criminal law of the people's Republic of China
Article 224
Under any of the following circumstances, it constitutes the crime of contract fraud. In the process of signing and performing a contract, the other party is defrauded of property for the purpose of illegal possession. If the amount is relatively large, he shall be sentenced to fixed-term imprisonment of not more than three years or criminal detention, and shall also or shall 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 three years but not more than ten years and shall also be fined; 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 or life imprisonment, and shall also be fined or confiscated:
(1) Signing a contract in the name of a fictitious unit or others;
(2) Mortgaging with forged, altered or invalid bills or other false property rights certificates;
(three) to perform a small contract or part of the contract first, to deceive the other party to continue to sign and perform the contract, and to have no actual performance ability;
(4) After receiving the payment for goods, advance payment or secured property paid by the other party;
(5) defrauding the other party's property by other means.
Article 266
If the crime of fraud defrauds public or private property, and the amount is relatively large, it 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 three years but not more than ten years and shall also be fined; 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 or life imprisonment, and shall also be fined or confiscated. Where there are other provisions in this Law, such provisions shall prevail.
Second, what are the conditions for medical insurance reimbursement?
1, see a doctor and buy medicine at a specific place.
The insured must go to the designated medical institutions of basic medical insurance or the medical prescriptions issued by doctors in specific hospitals to buy medicines at retail pharmacies determined by social medical institutions.
2. In medical insurance coverage.
The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, diagnosis and treatment items, the scope of medical service facilities standards and payment standards, and can be paid by the basic medical insurance fund according to regulations.
3. Repay in proportion
Among the medical expenses that the insured person meets the scope of payment of basic medical insurance, the part that is higher than the Qifubiaozhun of the social medical co-ordination fund and lower than the limit of the highest payment standard shall be paid by the social medical co-ordination fund in a unified proportion.
Our country has made a very clear explanation on the constitutive elements of fraud. Under normal circumstances, if it does not constitute value insurance, fraud or other types of fraud in the medical industry, it may also constitute fraud, but it must reach a large amount.