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Printing "Guiding Opinions on Several Issues on Criminal Criminal Cases for Medical Insurance"
Each province、Autonomous Region、The High People's Court of the Municipal Government、Today's European Cup football schedulePeople's Procuratorate、Public Security Department (Bureau)，The PLA Military Court、Military Procuratorate，Xinjiang Uygur Autonomous Region Senior People's Court Production and Construction Corps Branch，Xinjiang Production and Construction Corps People's Procuratorate、Public Security Bureau:
Punishment of medical and insurance insurance crimes in accordance with the law，Effectively maintain the safety of the medical security fund，Maintain the legitimate rights and interests of the people's medical security，Combined with the actual work，The Supreme People's Court、Supreme Today's European Cup football schedulePeople's Procuratorate、The Ministry of Public Security is jointly issued "Guiding Opinions on Several Issues on Criminal Criminal Cases for Medical Insurance"，Please implement it carefully。major problems encountered during execution，Please report the Supreme People's Court、Supreme People's Procuratorate、Ministry of Public Security。
The Supreme People's Court Supreme People's Procuratorate
Ministry of Public Security
February 28, 2024
The Ministry of Public Security of the Supreme People's Procuratorate of the Supreme People's Court
Several issues on handling medical insurance fraud cases
Guidance
Punishment of medical and insurance insurance crimes in accordance with the law，Maintenance of Medical Security Fund Security，Maintain the legitimate rights and interests of the people，According to the Criminal Law of the People's Republic of China、The Criminal Procedure Law of the People's Republic of China，Several issues on the case of medical insurance fraudulent criminal cases are put forward the following opinions。
1. Fully grasp the overall requirements
1. Deep understanding of the significance of punishing medical insurance and insurance crimes in accordance with the law。Medical Security Fund is the "seeing a doctor" for the people、"Help Money"，Reason for the vital interests of the people，Allegation for the healthy development of the medical security system，It's about the long -term security of the country。It is necessary to effectively raise political standing，Deep understanding of the significant significance of punishing the crime of medical insurance for medical insurance in accordance with the law，Continue deepening medical insurance fraudulent issues，Strictly Today's European Cup football schedulepunish medical insurance defrauding crimes in accordance with the law，Effectively maintain the safety of the medical security fund，Maintain the legitimate rights and interests of the people's medical security，Promoting the healthy and sustainable development of the medical security system，Constantly improving the people's sense of gain、Happiness sensation、Safety feel。
2. Persist in handling cases strictly in accordance with the law。Adhere to facts based on facts、Taking the law as the criterion，Persistence of punishment、Evidence referee、Suspects from Legal Principles，Strictly follow the evidence certification standard and requirements，Full collection、Fixed、Examination and identification evidence，Make sure that the facts of each medical insurance fraud insurance case are clear，Evidence is true、Enough，Confliction accuracy，Proper sentencing，Program legal。Effectively implement the lenient and strict criminal policy and confessing and confession from the width system，This width is width，When strictness is strict，Kuan Yan Xiang Ji，Punishment as a crime，Ensure that the crime is adaptive，Realize political effects、Unification of legal effect and social effect。
3. Persist in division of labor and responsibility、Cooperate with each other、Rebelling each other。Public security organs、Today's European Cup football schedulePeople's Procuratorate、The people's court must give full play to investigation、Prosecution、Judgment functions，Strengthen Today's European Cup football schedulecollaboration and cooperation，Establish a long -term working mechanism，Form working together，According to law、Timely、Effective punishment of medical insurance fraud crimes。Adhere to trial centers，Reinforcement of evidence、Program consciousness、Judgment Awareness，Give full play to the trial of the court to find out the facts、Protection right、Protection right、The decisive role in the justice of the referee，Effectively strengthen legal supervision，Ensure strict law enforcement、Justice justice，Improve judicial credibility。
2. Accurately identify medical insurance fraud crimes
4. Criminal cases of medical insurance for medical deficit insurance referred to in this opinion，refers to the use of deception，Criminal cases of deceiving the medical security fund。
Medical Security Fund includes basic medical insurance (including maternity insurance) funds、Medical Rescue Fund、Subsidy medical expenses for employees、Medical subsidies for civil servants、Residents' Disease Insurance Funds, etc.。
5. Fixed -point pharmaceutical institution (medical institution、Drug business unit) For the purpose of illegal possession，Implement one of the following behaviors，Fraud with the expenditure of the medical security fund，For the organization、Planning、Executive staff，According to the provisions of Article 266 of the Criminal Law，Crimes punishment with fraud; at the same time, it constitutes other crimes，Conflicia and punishment in accordance with heavy punishment:
(1) induction、Assist others to take names or seek medical treatment、Buying medicine，Provide false certification materials，or stringing to other people to open the cost document;
(2) Forgery、STC、Hidden、Modification、Destroy medical documents、Medical Certificate、Accounting 2024 European Cup Football WebsiteVolume、Electronic information、Test reports and other relevant information;
(3) Fictional pharmaceutical service items、The expense of medical service services in virtual opening;
(4) Decompire the hospitalization and hanging bed and hospitalization;
(5) Repeat charge、Super standard charges、Decomposition project charges;
(6) Change drugs、Medical consumables、Diagnosis and treatment items and service facilities;
(7) Including medical expenses that are not paid by the medical security fund in the medical insurance fund settlement;
(8) Other behaviors of other fraud medical security funds。
The fixed -point pharmaceutical institution shall be recovered by the medical security fund that the behavior stipulated in the previous paragraph.。
State staff of the designated pharmaceutical institution，Use job convenience，Implement the behavior specified in the first paragraph，Fraud for the Medical Security Fund，According to Article 382 of the Criminal Law、Regulations of Article 383，Concerning punishment for corruption。
6. The actor for the purpose of illegal possession，Implement one of the following behaviors，Fraud with the expenditure of the medical security fund，According to the provisions of Article 266 of the Criminal Law，Crimes punishment with fraud; at the same time, it constitutes other crimes，Conflicia and punishment in accordance with heavy punishment:
(1) Forgery、STC、Hidden、Modification、Destroy medical documents、Medical Certificate、Accounting 2024 European Cup Football WebsiteVolume、Electronic information、Test reports and other relevant information;
(2) Use other people's medical security vouchers to seek medical treatment、Purchase of medicine;
(3) Fictional pharmaceutical service items、The expense of medical service services in virtual opening;
(4) Repeat medical security treatment;
(5) Use the opportunity to enjoy medical security treatment to resold medicines、Medical consumables, etc.，Accept return cash、physical or other illegal interests;
(6) Other behaviors of other cheating medical security funds。
The personal account of insured persons shall pay for the medical expenses affordable by personal burden of personal affordable medical institutions in accordance with relevant regulations，Buy medicines at fixed -point retail pharmacies、Medical Device、The cost of personal burden that the medical consumables occurred，Not a name specified in the preceding paragraph (2) of the preceding paragraph、Buying medicine。
7.，Fraud with the expenditure of the medical security fund，According to Article 382 of the Criminal Law、Regulations of Article 383，Concerning punishment for corruption。
8. For the purpose of deceiving the medical security fund，Buy other people's medical security vouchers (social security card, etc.) and use，At the same time, it constitutes the crime of buying and selling identity documents、Use a false identity document crime、The crime of fraud，Conflicia and punishment with a heavier penalty。
Stealing the medical security voucher (social security card, etc.)，Anding the personal medical insurance account funds，According to the provisions of Article 264 of the Criminal Law，Concerning punishment for theft。
9. Knowing that it is a drug purchased by medical insurance fraud instead of purchased, illegal acquisition、Sales，According to the provisions of Article 312 of the Criminal Law and related judicial interpretations，To cover up、Concealing the crime and punishment of the crime; instructions、Express、I want others to use medical insurance fraud insurance to buy medicines，Then illegal acquisition、Sales，According to the provisions of Article 266 of the Criminal Law，Concerning punishment with fraud。
Whether the actor who uses medical insurance fraud to purchase drugs is pursued by criminal liability，It does not affect illegal acquisition、Sales of the acting of related drugs conviction and punishment。
A subjective knowledge specified in the first paragraph，It should be according to the medicine logo、Acquisition channel、Price、scale and pharmaceutical traceability 2024 European Cup live score results bettinginformation and other comprehensive identification。One of the following circumstances，It can be determined that the actor has a subjective knowledge，But the actor can explain the legal source of the drug or make a reasonable explanation:
(1) Drug prices are obviously different from market prices;
(2) Once due to illegal acquisitions、Sales of drugs purchased by medical insurance fraud，Those who have been punished by criminal or administrative penalties;
(3) illegal acquisition、Sales basic medical insurance drugs as a industry;
(4) Long -term or multiple times to acquire from unspecified transactions、Sales of basic medical insurance drugs;
(5) Use the Internet、Mailing and other non -contact channels for multiple acquisitions、Sales of basic medical insurance drugs;
(6) Others who are sufficient to identify the subjective knowledge of the perpetrator.
Third, punish medical insurance fraud crimes in accordance with the law
10. Strict punishment of medical insurance fraud crimes in accordance with the law，Focus on cracking down on behind -the -scenes organizers、Professional deception insurer, etc.，For it, there is a retreat and refund compensation、Confinement and punishment, etc.，It is also necessary to strictly grasp the width。
With one of the following circumstances, you can punish it from heavy punishment:
(1) Organization、Commanding criminal gangs to deceive the medical security fund;
(2) It was criminally investigated for medical insurance fraud insurance;
(3) If you refuse to refund the stolen and refund or transfer your property;
(4) Causes other serious consequences or harsh social impacts。
11. Criminal cases for medical insurance fraud，To review money laundering simultaneously、11. Criminal cases for medical insurance fraud，Implement the full chain punishment in accordance with the law。To combine normalization to carry out anti -crime and eliminate evil struggle，Discover、Identification of the possibilities of the evil forces in the medical insurance school，Deep excavation of corruption and "protective umbrella" behind the crime of medical insurance deficit insurance，and resolutely punish it according to law。
12. Whether the actor who implements medical insurance deficit insurance is held criminally responsible，The amount of the medical security fund should be comprehensively cheated、means、Confused Regret、Specific circumstances such as refunding stolen and refund compensation，Decisions according to law。
There are many people involved，Depending on the facts of the crime、The nature of crime、The plot and the degree of harm to society，and status in common crimes、Function、Specific implementation behavior Differential treatment、Differential treatment。First offenders who are not involved in the case、Occasionally criminals from light punishment，Medical staff who pleaded guilty and confession、Patients can punish it from wide punishment，Where，Mild crime plot，It can not be prosecuted or exempted from punishment according to law; the plot is significantly mild、Low -harmful，Not dealing with crime treatment。
13. Properly apply probation according to law，To consider the crime plot、Repentance performance、The danger of crime and the impact of announcement on the community of the residence，Make a decision in accordance with the law。The primary molecules of criminal group、Professional deception Bet on today's European Cup matchesinsurer、He has been criminally investigated for criminal crimes for medical insurance，Destruction、Forgery、Hide evidence，Refusing to refund the liability for refund or transfer property，Generally not applicable to probation。Criminals who announced probation，According to the crime situation，It can be prohibited from engaging in specific activities related to medical security funds during the probation test period。
14. Use full use of property sentences in accordance with the law，Increase fines、Confiscation of property，Improve the cost of crime of medical insurance fraud，Strictly sanction criminals。To comprehensively consider the amount of crime、Refunding the stolen and refunding compensation、Crime confession and other circumstances determine the amount of fines。
4. Effectively strengthen the collection, review and judgment of evidence
15. Medical Insurance Fraud Criminal Case Chain Long、hidden depth、difficulty in obtaining evidence，Public security organs should strengthen investigation and evidence collection，Collect fixed evidence，Especially paying attention to collecting and fixed prescriptions、Medical records and other original evidence materials and the core evidence material for the implementation of falsification of falsifying the facts，Deeply find out the facts of the crime，Transfer to prosecution according to law。Beside、Difficulty、Complex and social impact、Cases with a high degree of attention，If necessary, you can listen to the opinions of the People's Procuratorate。
16. People's Procuratorate must perform legal supervision duties in accordance with the law，Strengthen the construction of the allegation system with evidence as the core，Strengthen the advance intervention of criminal cases of medical insurance fraud、Evidence review、Schedule supervision and other work，Actively guide public security organs to carry out investigations，Perfect the evidence system。
17. The people's court should strengthen the review of evidence of medical insurance fraudulent cases for criminal cases、Judgment，Comprehensive use evidence，Conducts the facts related to conviction and quantitative sentences、Determination，Make sure the facts of the case are clear，Evidence is true、Enough。I think it is necessary to supplement evidence，It should be recommended by the People's Procuratorate to supplement the investigation。
18. The medical security administrative department collected in the supervision and inspection and investigation、Documentary、Audiovisual information、Electronic data and other evidence materials，The prescribed by administrative regulations，The collection procedure meets the relevant laws、The prescribed by administrative regulations，can be used as a basis for the final case。
19. Criminal cases for medical insurance fraud，Due to the large number of witnesses and other objective conditions and other objective conditions limit，Unable to collect witness testimony，It can be combined with the collected witness testimony，and the verified bank account transaction records、Third -party payment settlement voucher、Account transaction records、Audit report、Data of medical insurance information system、Electronic data and other evidence，Comprehensive identification of criminal facts such as fraud。
20. Public security organs、Today's European Cup football schedulePeople's Procuratorate、The People's Court seizes the seal of the law、See、Frozen property involved，It should be fully collected、Review prove its source、Nature、Usage、Related evidence such as ownership and value，Treatment according to the facts of the foundation according to law。It is clear that the case is clearly unrelated to the case，It should be returned。
Public security organs、The People's Procuratorate shall review and identify the property involved in the case。Transferring prosecution、When the prosecution is mentioned，It should be handled on the property involved in the case。
21.，It should be recovered in accordance with the law or ordered a refund to the compensation。Real evidence proves that there is a property that should be recovered in accordance with the law，But the whereabouts cannot be found，or loss of value，or mixed with other legal property，You can recover the equivalent part of equivalent property or mixed property。The recovery amount of equivalent property is limited to detecting the amount of illegal income in accordance with the law，For the part that has been recovered or refunded, it should be deducted。
Evidence of the various circumstances of the previous paragraph，Should be retrieved in time。
22. Public security organs、Today's European Cup football schedulePeople's Procuratorate、The people's court must pursue the entire process and links of the case of pursuit of stolen stolen and losses，Fully pursuing stolen stolen losses，To chase it all。The People's Court in the process of implementing the property involved，Public security organs、People's Procuratorate and relevant functional departments shall cooperate，Performing the collaboration obligations，Comprehensive use of multiple means，Do a good job of clearing the property involved、Realization of property、Fund collection and property return，minimize the loss of medical security fund，Maximum the interests of the people。
5. Establish a sound collaborative cooperation mechanism
23. Public security organs、The People's Procuratorate's medical security administrative department in the process of investigating medical insurance insurance or administrative law enforcement，It is believed that the case is important and difficult to complicate，Please ask for prosecution standards、Evidence fixation and other questions to ask for consultation or reference opinion，It should be made in time。
Public security organs need to investigate the clues of medical insurance fraud in the medical insurance administrative department in time，If necessary, please help the relevant departments to assist and provide relevant evidence materials，Timely file investigation of suspected crimes。Medical Security Administrative Department or relevant administrative department and pharmaceutical institutions shall actively cooperate with the case handling authorities to retrieve relevant evidence，Do the fixation and storage of evidence。
Public security organs、Today's European Cup football schedulePeople's Procuratorate、The People's Court does not constitute a crime、Medical Insurance Crack Insurance Owners who do not prosecute in accordance with the law or are exempted from criminal punishment，You need to give administrative penalties、Government Affairs or other sanctions，shall be transferred to the medical security administrative department and other relevant agencies to deal with it。
24. Public security organs、Today's European Cup football schedulePeople's Procuratorate、The People's Court and the Medical Security Administrative Department must strengthen Today's European Cup football schedulecollaboration and cooperation，Improve the preliminary investigation of criminal cases of medical insurance insurance insurance、Investigation of the case、Examine and prosecution、Work mechanism of trial execution，perfect clue discovery、Check、Transfer、Treatment and feedback mechanism，Strengthen the analysis and judgment of the clue of the clue of medical insurance fraud insurance，Timely discover、Effective prevention and punishment of crime。Public security organs and medical security administrative departments must accelerate information sharing，Build a real -time analysis and early warning monitoring model，Strive for medical insurance fraudulent issues "Discover early、Strike in early "，Maximum loss loss。
Public security organs、Today's European Cup football schedulePeople's Procuratorate、The People's Court shall promptly report the results of medical insurance fraud case handling and effective documents in time to report the medical security administrative department。
25. Public security organs、Today's European Cup football schedulePeople's Procuratorate、When the People's Court handle medical insurance fraudulent criminal cases，Keyou invite medical security administrative departments or relevant administrative departments to assign professionals to cooperate with work，Assistance to check、Copy related professional information or account for the loss of the loss of the medical security fund，Issuing opinions on professional issues involved in the case。Matters involved in administrative treatment，It should be transferred to the medical security administrative department or the relevant administrative department to deal with it in accordance with the law。
26. Public security organs、Today's European Cup football schedulePeople's Procuratorate、People's Court must actively perform duties，Further extension of the case handling function，Publish typical cases in time according to the situation、Carry out the case of the case，Strengthening the publicity and education of the rule of law，Promote the masses' knowledge、Law，Jointly maintain the normal operation of the medical security fund and the medical and health order。Combined with the case of the case found that the medical security fund is used、Supervision and other problems，Send a prompt letter to the relevant departments、Procuratorial Suggestions、Judicial Suggestions，Pay attention to tracking and questioning，Establish and improve the long -term mechanism of preventing illegal crimes against medical insurance deficit insurance，Throughout the breeding soil of illegal crimes of medical insurance deficit insurance。