The Supreme People's Court, the Supreme People's Procuratorate, and the Ministry of Public Security jointly held a press conference today (1st). The press conference announced typical cases of cracking down on "reflux drug" insurance fraud in the whole chain, and exposed the crime of "reflux drug" insurance fraud. means and harmfulness.
"Reflux drugs" in medical insurance refers to the perpetrator fraudulently using other people's medical insurance certificates, or the insured using medical insurance reimbursement to purchase drugs from designated medical institutions, and increasing the price according to the actual cost paid to the drug supplier. The cost of drug purchase is borne by the individual, and the drug ** merchant sells the drug. Go to medical institutions, clinics, etc., and then sell them to patients.
The facts of a typical case show that from January 2017 to September 2020, the defendant Ma Mouyu repeatedly used the social security cards of 11 people, including Zhao, to pretend to seek medical treatment and purchase medicines, and sold some drugs to medical institutions in Beijing. and other places. Qu, Zhou (both sentenced) and others. Ma Mouyu defrauded a total of more than 440,000 yuan in medical security funds.
After trial, the Beijing Miyun District People's Court held that Ma Mouyu used other people's social security cards for the purpose of illegal possession, fabricated facts, concealed the truth, and defrauded a huge amount of medical insurance funds, and his behavior constituted the crime of fraud. 。Ma Mouyu voluntarily pleaded guilty and may be given a lighter punishment. Accordingly, Ma Mouyu committed the crime of fraud and was sentenced to eight years and three months in prison, deprived of political rights for one year, and fined 80,000 yuan. Ma appealed. The Beijing No. 3 Intermediate People's Court rendered a judgment in accordance with law, rejecting the appeal and upholding the original judgment.
The Supreme People's Court held that the crime of "reflux drugs" fraud insurance showed a tendency to be specialized, forming a closed loop of "card collection, medical insurance prescription, drug collection, sales to medical institutions, and patients purchasing drugs". The actors, insureds, drug recipients, and medical institutions involved in each link are all "co-beneficiaries", which jointly cause losses to the medical insurance, damage the interests of all the insured, and the quality of the drug is difficult to guarantee. Guarantee.
According to the Supreme People's Court and the Supreme People's Procuratorate's "Interpretation on Several Issues Concerning the Application of Law in Handling Criminal Cases Endangering Drug Safety", it is clear that medical insurance fraud was used to illegally purchase and sell drugs, and the amount exceeds the penalty of 50,000 yuan in accordance with article 1 of the Criminal Law. In accordance with article 312, being convicted and punished for concealing or concealing criminal proceeds; Those who instigate, instigate, or instigate others to use medical insurance to fraudulently purchase drugs, and then illegally buy or sell them, are to be in accordance with the provisions of article 266 of the Criminal Law. Convicted and punished for fraud. If the insured person takes advantage of the opportunity to enjoy medical security benefits to resell drugs, accept cashbacks, goods or other illegal benefits, which constitutes a crime, he shall be investigated for criminal responsibility in accordance with law.
CCTV reporter Zhang Sai Liming).
CCTV news client.
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