On The Qualification Of The Behavior Of Medical Insurance Fund

China is now still in the period of economic reform, recalling decades of struggle, rapid economic development, we have achieved fruitful results. While developing countries in economy, but also vigorously to establish and develop a basic security system of people’s lives, the late 90 s of last century, the state began in the establishment of the basic medical insurance system, and now, the basic medical insurance has entered every household, has become Many people receive medical care protection. Social security institutions and medical institutions designated medical service agreement signed, the insured person under the agreement, can enjoy basic medical services at designated medical institutions after paying the basic medical insurance. With the reform of the health care market economy gradually transformed, medical institutions to provide medical services to become the main market, making the medical market order also belongs to an important part of the socialist market economic order. Basic medical insurance system for the benefit of the people of this is a good thing, however imperfect transition system, making health insurance fund has become in the eyes of many medical institutions readily available "fat." Many hospitals by "hanging bed hospital," falsifying medical records and other methods to cheat Medicare funds frequent cases in the country, and a huge amount. Because of uncertain nature of the designated medical protocol to deal with such cases so that the judiciary has become a headache problem. This paper selects a hospital in Hainan real case defraud Medicare funds to define the nature of the designated medical protocol as a starting point, by discussing contract fraud, general fraud, crime on the basic unit of the criminal law theory, combined with a detailed analysis of the case, too the identification and methods of processing and analysis path in such cases, in order to be able to provide guidance for future similar cases.Article is divided into four parts:The first part, the main cause of action by a brief description of the case, the case, as well as summarize the parties to the case because of disagreements arising from the behavior of a hospital and president of Hainan Province contract fraud, general fraud, guilty of abuse of power Several crime perspective. Summed up the debate by disagreements focus is uncertain nature of the designated medical service agreement, whether contract fraud in the range "of the contract."The second part is the analysis of the legal issues related to, first of all discuss the definition of the nature of the designated medical service agreement, through a comparative analysis of the various viewpoints, I believe that the medical service agreement involved a civil contract rather than administrative contract. Secondly, according to contract fraud charges mainly related to controversial opinions, fraud, crime of abuse of state-owned unit personnel, as well as the crime of the basic theory of criminal law involved in the crime unit, the author in this part of the above-mentioned charges involved for a more in-depth analysis The main constituent elements of contract fraud analysis and comparison of common fraud, discusses the differences between the two crimes and applicable. Because the case is a unit of the crime, the author of this processing unit also discussed the implementation of common fraud. In addition, a state-owned hospital case the defendant hospital, the president of state-owned institutions in line with the qualification of personnel, I also briefly discussed the state-owned institutions constitute the crime of abuse of staff.The third part, the case analysis conclusions. In this section, the author of a civil contract, said point of view adopted by the theory of the case to the designated medical service protocols defined as a civil contract, and on this basis that the medical service agreement contract fraud in areas belonging to the "contract", but this case highlights the constituent elements of contract fraud, rejected the argument of the other differences in opinion, and a detailed description of the discussion. Finally, the analysis concluded contract fraud case should be handled units in a conviction.The fourth part, by analyzing the foregoing conclusion, lead author of Reflections on the treatment of such cases. Because our country is in transition, sound system has always been a lag, has repeatedly called for timely resolution can not be real cases, therefore, the author of the judiciary more inclined to deal with similar cases in the future, specific conditions, according to the designated medical protocol is a civil contract or administrative contract is determined to implement the contract fraud unit qualitative or criminally prosecuted in ordinary fraud unit directly responsible personnel, should not one size fits all approach.