Medical insurance is the people's "medical money" and "life-saving money", and the crime of medical insurance fraud seriously endangers the safety of medical insurance and damages the legitimate rights and interests of the people's medical security. On March 1, the Supreme People's Court, the Supreme People's Procuratorate, and the Ministry of Public Security jointly held a press conference to issue the "Guiding Opinions on Several Issues Concerning the Handling of Criminal Cases of Medical Insurance Fraud", further clarifying the conviction and punishment of medical insurance fraud, the application of law, the grasp of policies, the requirements for handling cases, and relevant work systems and mechanisms.
The proportion of insured persons involved in medical insurance fraud was 5408%
Chen Xueyong, vice president of the Third Criminal Division of the Supreme People's Court, said that in recent years, the people's courts have given full play to their criminal trial functions and tried a number of cases of medical insurance fraud in accordance with the law, achieving good political, legal and social effects.
According to incomplete statistics, from 2021 to 2023, courts across the country will conclude a total of 1,213 cases of medical insurance fraud in the first instance, of which 306 cases will be concluded in 2021, 407 cases will be concluded in 2022, and 500 cases will be concluded in 2023, a year-on-year increase respectively85%, and the number of cases is increasing year by year and the increase is large.
The crimes involved are centralized, mainly fraud. The crime of medical insurance fraud involves a number of common crimes such as fraud, covering up and concealing criminal proceeds, and ** crimes, of which fraud accounts for 9365%。
The main body of the crime is diversified, and the proportion of insured persons is more than half of them. The criminal subjects of medical insurance fraud include designated medical institutions and their personnel, designated retail pharmacies and their personnel, insured persons and their close relatives, professional insurance fraud gangs and other personnel, and some cases also involve drug manufacturers. Among them, the insured persons were involved in 5408%。
The criminal methods are diversified, and the professional insurance fraud is specialized. In practice, the criminal methods of medical insurance fraud mainly include forging supporting materials, issuing false expense documents, fictitious medical services, decomposing items, colluding drugs, seeking medical treatment under false names, purchasing drugs, and reselling drugs by taking advantage of medical security benefits.
The amount of crime is huge, and the harm to society is serious. Some medical insurance fraud crimes are highly concealed, last for a long time, and involve huge amounts of money, resulting in irreparable huge medical insurance losses and seriously damaging the healthy and sustainable development of the medical security system. For example, in the typical cases released, Liu Mou A, Liu Mou B, and Liu Mou C criminal group fraud case, defrauding medical insurance** up to more than 100 million yuan; The fraud case of the defendant Pan Mouchun and others tried by the Binhu District Court of Wuxi City, Jiangsu Province, caused a loss of more than 32 million yuan in medical security; The Chongqing Municipal People's Court concluded 49 cases in the first instance, involving a total amount of more than 8,900 yuan.
Focus on cracking down on behind-the-scenes organizers, professional insurance fraudsters, etc
In recent years, medical insurance fraud crimes have emerged one after another, and major cases have occurred frequently, seriously endangering the safety of medical insurance, harming the legitimate rights and interests of the people's medical security, and causing great harm to society. The "Guiding Opinions on Several Issues Concerning the Handling of Criminal Cases of Medical Insurance Fraud" and the typical cases of the "Two Supreme People's Courts" on punishing the crime of medical insurance fraud in accordance with the law issued by the "Two Supreme People's Courts and the First Committee" further clarified the issues such as the conviction and punishment, application of law, and policy grasp of the crime of medical insurance fraud, and provided a clear legal and policy basis for punishing the crime of medical insurance fraud in accordance with the law.
Increase the severity of punishment. It is required that the crime of medical insurance fraud be severely punished in accordance with the law, focusing on cracking down on behind-the-scenes organizers, professional insurance fraudsters, and the ringleaders who organize and lead criminal groups, etc., and resolutely resentence those who should be sentenced in accordance with law. At the same time, earnestly implement the criminal policy of blending leniency with severity and the system of leniency for those who admit guilt and accept punishment, and strive to achieve the best political, legal, and social effects. The Supreme People's Court will supervise the handling of a number of major cases, strengthen supervision and guidance, and ensure the effectiveness of case handling.
Strengthen the recovery of stolen goods and losses. Make the recovery of stolen goods and losses run through the entire process and all aspects of handling cases, increase the force of sentencing and enforcement of property penalties, and lawfully recover or order restitution of all property obtained by the perpetrator's criminal practice of medical insurance fraud. Comprehensively use a variety of means to do a good job in the removal and transportation of assets involved in the case, the realization of assets, the collection of funds, and the return of assets, to minimize the loss of medical security, and to protect the interests of the people to the greatest extent.
Strengthen synergy. Strengthen communication, coordination, coordination and cooperation with departments such as public security, procuratorate, medical insurance, and health, improve working mechanisms, and form a strong joint force to ensure effective crackdowns and effective punishments. The Supreme People's Court will work with relevant departments to jointly carry out the 2024 special rectification work on combating fraud and insurance fraud in the field of medical insurance to ensure that the special rectification work achieves practical results.
Strengthen the governance of litigation sources. Persist in placing equal emphasis on crime and governance, actively perform their duties in accordance with the law, actively participate in corporate compliance reforms, combine the handling of cases, conduct in-depth research and summaries, discover problems and loopholes in social governance and industry regulation, and submit targeted judicial recommendations to relevant departments, prompting relevant departments to improve supervision and plug loopholes, promote governance in accordance with law, systematic governance, comprehensive governance, and governance at the source, and establish and improve long-term effective mechanisms for preventing violations and crimes of medical insurance fraud.
In the next step, the people's courts will actively perform their duties in accordance with the law, punish the crime of medical insurance fraud in accordance with the law, and earnestly safeguard the safety of medical insurance and the vital interests of the people.