1, the filing standard of medical fraud is the filing standard of ordinary fraud;

2, insurance fraud, suspected of one of the following circumstances, should be filed for prosecution:

3 individuals engaged in insurance fraud, the amount of more than ten thousand yuan;

4, unit insurance fraud, the amount of more than fifty thousand yuan.

The types of medical insurance fraud are as follows:

1, designated medical institutions: inducing and defrauding the insured to be hospitalized; Detaining, embezzling or fraudulently using the social security card of the insured; Inconsistent witness, malicious hospitalization, fictitious medical service, forged medical documents or bills; Assist the insured to prescribe drugs to realize cash, so as to obtain medical insurance funds; False records, repeated records of drugs, diagnosis and treatment items, medical consumables and medical service facilities; Exchanging medicines, instruments and diagnosis and treatment items; Breakdown charges, over-standard charges, repeated charges, application of project charges, etc. ;

2. Designated retail pharmacies: false records and multiple drugs; Medicine for medicine, medicine for things, medicine for things to take medical insurance fund; Induce the insured to keep an empty social security card, etc.

3. Insured personnel: lend my social security card to others for use; Fraudulent use of other people's social security cards for medical treatment; Say that you are not sick, prescribe drugs to others, prescribe drugs too much, and resell drugs; Forging or falsely issuing medical bills for reimbursement; Collusion with designated medical insurance service institutions, swindling, over-recording, falsely recording medical insurance project expenses, empty brushing social security cards and rationing to buy drugs unrelated to my illness;

4. Employer: Forge employment relationship, fabricate employment relationship, and handle insurance for unqualified personnel; Cheating, lying about the number of employees, underreporting the payment of wages, etc.

To sum up, improve the understanding of the importance of medical insurance, comprehensively strengthen the leadership of medical insurance, clarify the division of responsibilities to people, and ensure the implementation of medical insurance objectives and tasks from the system; Secondly, organize all employees to study the relevant documents carefully, tell the typical cases of fraudulent insurance around them, strictly control the treatment items that do not meet the requirements and the drugs that should not be used according to the requirements of the documents, and establish the consciousness that "the medical insurance fund should not be cheated and the policy red line should not be stepped on" from the ideology of all employees; Resolutely put an end to the illegal phenomenon of defrauding medical insurance funds, build a brand of honest medical insurance, strengthen self-discipline management, and establish a good image of designated medical insurance units.

Legal basis:

Article 266 of the Criminal Law of People's Republic of China (PRC)

Definition and sentencing 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 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.