Research On The Crimes Of Basic Medical Insurance Fraud In China

As the coverage of basic medical insurance continues to expand,the medical insurance fund,as a social "safety net" and "stabiliser",is facing serious security problems.At present,China has achieved certain results in combating basic medical insurance fraud,but there are still some real problems in crime management.Against this background,this study takes "basic medical insurance fraud crime" as the research theme,and uses the collected criminal cases and semi-structured interviews as the data source to outline the current characteristics of basic medical insurance fraud crime in China.Firstly,a descriptive statistical analysis and a comparative test were conducted on a sample of 219 criminal judgments from the Chinese Judicial Documents website to objectively describe the general situation and specific characteristics of basic medical insurance fraud crimes in China.Finally,the theoretical framework of criminology is combined to explain the causes of basic medical insurance fraud crimes in China,and to propose targeted crime prevention and control countermeasures accordingly.This study finds that,from a general perspective,the number of related crimes is generally distributed in an inverted U-shape;from the operation mode of the crimes,the related crimes can be basically divided into supply-led fraud,demand-led fraud and insurer-led fraud;from the specific characteristics of the crimes,the subjects of the crimes are concentrated in middle-aged men,the crimes mostly occur in primary medical institutions,the acts last longer,the types are complex,and especially In terms of the specific characteristics of the crime,the main perpetrators are middle-aged males,the crimes are mostly committed in primary care institutions,the behaviour is long-lasting and complex,and the supply-led fictitious compound fraud often causes greater social harm.Based on the above findings,this study constructs the analytical framework of this paper from the perspectives of potential perpetrators,criminal target attributes and protector deficits,based on everyday activity theory,combined with a cost-benefit analysis model of crime,and draws conclusions from the study.The conclusions show that potential perpetrators arise from the cost-benefit differential in the healthcare professional environment,the accessibility of crime targets arises from the quasi-public good attributes of health insurance funds and the inadequate internal control mechanisms of healthcare institutions,and control omissions arise from the deficiencies of non-physical entity protectors consisting of institutional systems and regulatory measures.Therefore,in order to prevent the convergence of criminal elements and to guard the people’s "life-saving money" for medical treatment,it is necessary to build a collaborative governance system among the government,the market and society,to prevent and reduce crime by reducing the criminal motives for health insurance fraud,optimising the internal constraints of medical institutions and improving the external control of health insurance funds.