Research On The Crime Of Medical Insurance Fraud

Social medical insurance security system is an important welfare system for the people's livelihood.The implementation of social medical insurance system has improved the medical dilemma of difficult and expensive medical treatment to a certain extent.With the continuous improvement of the coverage rate of medical insurance,the funds of medical insurance fund are constantly full.As a result,the fraud of medical insurance is becoming more and more serious,and the means of fraud are constantly upgrading,so it is difficult to punish in practice.In this way,Chinese scholars constantly call for the medical insurance fraud to be included in the criminal law,but there are disputes on how to convict and sentence.On April 24,2014,the Standing Committee of the National People's Congress issued a legislative interpretation to define fraud of social insurance such as medical insurance as fraud.The introduction of legislative interpretation solves the urgent need of qualitative analysis,but in judicial practice,the identification of this behavior is still confused.In order to explore the regulatory path of medical insurance fraud in China,first of all,this paper attempts to start from practice,fully understand the current medical insurance fraud,which is mainly manifested in the insurance participants,designated medical institutions,professional insurance frauds,criminal gangs and payment units.The characteristics of the crime of medical insurance fraud are:the main body of the crime is mixed,the forms of fraud are complex and diverse,the means are hidden,the scope of involvement is wide,the status quo,the forms and characteristics of the behavior of brokers are often existed.Secondly,through the analysis of the current criminal law regulation of medical insurance fraud,we can see that the current legislation explains the limitations of the regulation of medical insurance fraud,there are differences in the judicial treatment of medical insurance fraud in the practice field,the judicial basis of anti medical insurance fraud is too scattered,and the judicial chaos in the poor connection between administrative treatment and criminal law.And the theoretical circles also have doubts and disputes about the medical insurance fraud,mainly reflected in the doubts on the legislative interpretation and the debate on the nature of the medical insurance fraud.So as to clarify the problems existing in the anti fraud mechanism of medical insurance in China.Secondly,with a full understanding of the inadequate regulation of medical insurance fraud in our country,the investigation on the anti fraud system of medical insurance in the countries with relatively perfect external social security system shows that most countries adopt the principle of legislation first,that is,first build the legal system against medical insurance fraud,and then take measures such as risk assessment of medical insurance and strict adherence to medical insurance Fund payment and other fraud prevention and control means.Finally,on this basis,the regulatory path of medical insurance fraud is envisaged.This paper proposes to formulate a unified social insurance anti fraud legislation,set up a crime of social insurance fraud,and conceive the Constitution and criminal law setting of the crime of social insurance fraud.In order to provide reference suggestions for criminal legislation and judicial practice.