1. Fictitious medical services, forged medical documents and bills, and defrauded medical insurance funds;

2. Providing false invoices for the insured;

3, will be borne by the individual medical expenses credited to the medical insurance fund payment range;

4. Handling medical insurance benefits for those who have not participated in medical insurance;

5. Provide credit card bookkeeping services for non-designated medical institutions;

6. Nominal hospitalization;

7. Exchange of medicines, consumables, articles and medical items. Defrauding medical insurance fund expenditures;

8 other fraudulent acts of designated medical institutions and their staff.

The fraudulent acts of designated retail pharmacies and their staff are as follows:

1, fabricating medical services, forging medical documents and bills, and defrauding medical insurance funds;

2. Providing false invoices for the insured;

3, will be borne by the individual medical expenses credited to the medical insurance fund payment range;

4. Handling medical insurance benefits for those who have not participated in medical insurance;

5. Provide credit card bookkeeping services for non-designated medical institutions;

6. Nominal hospitalization;

7. Exchange of medicines, consumables, articles and medical items. Defrauding medical insurance fund expenditures;

8 other fraudulent acts of designated medical institutions and their staff.

To sum up, defrauding medical insurance refers to deliberately obtaining medical insurance reimbursement by fraudulent means or obtaining undeserved medical insurance benefits. If you suspect that you or others have defrauded medical insurance, it is recommended to report it to the local medical insurance institution or law enforcement department so that they can investigate and deal with it.

Legal basis:

Article 198 of the Criminal Law of People's Republic of China (PRC)

If one of the following circumstances constitutes the crime of insurance fraud, and 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 confiscated property:

(1) The applicant intentionally fabricates the subject matter of insurance to defraud the insurance money;

(2) The applicant, the insured or the beneficiary fabricates false reasons or exaggerates the loss of the insured accident to defraud the insurance money.

(3) The applicant, the insured or the beneficiary fabricates an insurance accident that has never happened to defraud the insurance money;

(4) The applicant or the insured intentionally causes an insurance accident that causes property losses and defrauds the insurance money;

(5) The applicant or beneficiary intentionally causes the death, disability or illness of the insured to defraud the insurance money.

Whoever commits the acts listed in Items 4 and 5 of the preceding paragraph, which constitutes other crimes, shall be punished in accordance with the provisions of combined punishment for several crimes. If a unit commits the crime mentioned in the first paragraph, it shall be fined, and the directly responsible person in charge and other directly responsible personnel shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention; 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; 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. If an appraiser, witness or property appraiser of an insurance accident intentionally provides false documents to provide conditions for others to cheat, he shall be punished as * * * insurance fraud.