I was injured working for someone, but I made up a reason to go to NCMS for reimbursement, and committed the crime of fraud!
The New Rural Cooperative System is an important policy that benefits thousands of farmers, but it has been targeted by some of the best people, who use fake patients, fake illnesses, fake bills and other fraudulent behaviors to try to eat away at this "cake".
Xiao Ming, a resident of Changchun City, Jilin Province, was hired by others to break his leg when he fell while climbing a power pole in Changbai Mountain to install network cables.
In order to defraud the reimbursement of NCMS trauma, Xiao Ming issued false certification materials, pretending that he fell and injured himself while repairing his own house, and defrauded the NCMS trauma reimbursement of more than 24,000 yuan.
After the matter was revealed, Xiao Ming withdrew from the fraudulent money.
After trial, the court held that Xiao Ming, for the purpose of illegal possession, fabricated facts to defraud the state's new type of rural cooperative medical subsidy funds, and the amount was relatively large, and his behavior constituted the crime of fraud, and combined with the facts and specific circumstances of this case, Xiao Ming was sentenced to one year in prison, suspended for one year, and fined 16,000 yuan.
According to the relevant laws of China, if there is a third-party responsible person, then the medical insurance will not be reimbursed. Because there is a third-party responsible person, you can ask the third-party responsible person to bear the relevant responsibility, so the medical insurance will not reimburse.
Article 30 of the Social Insurance Law of the People's Republic of China stipulates that the following medical expenses are not included in the scope of payment of basic medical insurance**: (1) shall be paid from work-related injury insurance**;(2) It shall be borne by a third party;(3) shall be borne by public health;(4) Seeking medical treatment outside the country. Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.
Through the understanding of the law, we can know that if there is a third party liability, the medical expenses should be paid by the third party, unless the third party does not pay or is uncertain, the medical insurance will be paid in advance.
However, many people often hide the truth of their injuries and defraud medical insurance after claiming medical expenses from a third party in order to be greedy. This often involves the crime of fraud, and if the amount is larger, it will be investigated for criminal responsibility.