1. Is it fraudulent to use medical insurance?
Using medical insurance is a kind of fraud. Whoever defrauds public or private property in a relatively large amount shall be sentenced to fixed-term imprisonment of not more than three years, criminal detention or public surveillance, 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. Where there are other provisions in this Law, such provisions shall prevail.
Second, how to convict and sentence the hospital for defrauding the medical insurance fund
The Social Insurance Law stipulates that defrauding pension, medical care, work injury, unemployment, maternity and other social insurance benefits or other social insurance benefits by fraud, forgery of certification materials or other means belongs to the act of defrauding public and private property as stipulated in Article 266 of the Criminal Law. Deceiving medical insurance funds belongs to the act of defrauding the company's finance as stipulated in Article 266 of the Criminal Law of our country, and is punished as fraud. If the amount is relatively large, he 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.
3. What are the behaviors of insurance fraud?
There are five ways of insurance fraud:
(1) The property applicant deliberately fabricated the subject matter of insurance to defraud the insurance money.
The subject matter of insurance refers to the material wealth and related interests, human life, health or related interests as the subject matter of insurance. Deliberately fabricating the subject matter of insurance refers to deliberately fabricating the non-existent subject matter of insurance when concluding an insurance contract with the insurer. I thought I would fabricate an insurance accident to defraud the insurance money in the future.
(2) The applicant, the insured or the beneficiary fabricates false reasons or exaggerates the loss of the insured accident to defraud the insurance money. As stipulated in the insurance contract, the insurer is only liable for the insured accident caused by the reasons within the scope of insurance liability, and the applicant, the insured or the beneficiary conceals the real reasons of the insured accident or falsely claims that the reasons not within the scope of insurance liability are the reasons within the scope of insurance liability to defraud the insurance money; Causing losses to an insured accident that has occurred. Then deliberately exaggerate the degree of loss to defraud the extra 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. This refers to man-made insurance accidents during the insurance contract, resulting in property losses, in order to defraud insurance money.
(5) The applicant or beneficiary intentionally causes the death, disability or illness of the insured to defraud the insurance money. This refers to the act of deliberately using illegal means to defraud insurance money and create compensation conditions in personal insurance, resulting in casualties or diseases of the insured. If the actor commits one of the above five acts and defrauds a large amount of insurance money, it constitutes the crime of insurance fraud.
The purpose of medical insurance is to protect China citizens from medical treatment, not to defraud criminals of insurance money. Once this behavior occurs, it will be considered as fraud. According to the nature of the case and the amount of fraud, the criminal suspect is punished differently. The state resolutely cracked down on such illegal acts.