Mother and daughter were both sentenced for lying about "falling at home"
Obviously, he was injured in a traffic accident, but when he was hospitalized, he lied that he was injured at home by defrauding the medical insurance. Recently, the Procuratorate of Chongchuan District, Nantong City, Jiangsu Province filed a public prosecution against a case of fraudulent medical insurance funds. Two defendants were sentenced to one year’s imprisonment, suspended for one year and six months, and fined for committing fraud.
Wang Cuiying (pseudonym) is 70 years old and lives in Nantong City, Jiangsu Province. In 2017, Wang Cuiying was in a traffic accident with an electric bicycle driven by someone else while riding a bicycle. She fell on the spot and fractured her wrist and leg. After the accident, both parties negotiated on their own, reached a compensation agreement of 30,000 yuan, and applied to the traffic police team to close the case. On the day of the accident, Wang Cuiying was sent to the hospital for treatment, and then received 30,000 yuan in compensation from the perpetrator.
Afterwards, Wang Cuiying was transferred to another hospital in Nantong City for treatment. After being transferred to the hospital, Wang Cuiying knew that the medical expenses incurred by the traffic accident could not be directly paid by medical insurance, and still concealed the fact that the traffic accident caused the fracture from the doctor, falsely claiming that he was accidentally injured at home; when he went through the admission procedures, Daughter Wang Xiaotong (pseudonym) made a false promise in the medical insurance trauma approval form filled out for Wang Cuiying: "The trauma is caused by personal reasons, has nothing to do with any person or unit, and does not involve work-related injuries, fights, alcoholism, self-harm, or third-party compensation. If the situation is not true, I am willing to refund all losses and bear legal responsibility."
After more than 20 days of hospitalization, Wang Cuiying was discharged. At the time of discharge from the hospital, Wang Cuiying spent a total of 56995.61 yuan in medical treatment, of which 37846.42 yuan was paid for by medical insurance.
In 2018, the Nantong Medical Insurance Fund Management Center received a report from the public and immediately launched an investigation. It was discovered that Wang Cuiying and Wang Xiaotong were suspected of fraudulent medical insurance funds, and the case was transferred to the judicial authority for processing. In June 2020, Wang Cuiying and Wang Xiaotong were prosecuted by the Procuratorate of Chongchuan District, Nantong City on suspicion of fraud. The procuratorate charged that the mother and daughter defrauded 37846.42 yuan of medical insurance funds through medical insurance reimbursement, which constituted a crime of fraud.
Can I use medical insurance to pay for medical expenses if I am hospitalized in a traffic accident? This issue is related to personal health rights. The prosecutor quoted Article 30 of the "Social Insurance Law of the People's Republic of China" to explain: "Medical expenses that should be borne by a third party are not included in the scope of payment by the basic medical insurance fund. Medical expenses shall be borne by the third party in accordance with the law, and the third party shall not pay. Or if the third party cannot be determined, the basic medical insurance fund shall pay first. After the basic medical insurance fund is paid first, he has the right to claim compensation from the third person.” In this case, the defendant knew that his injury was caused by a traffic accident and there was a third party. Personal liability, according to the provisions of the Social Insurance Law, is not within the scope of medical insurance payment, but the cause of injury is concealed during medical settlement, in an attempt to obtain both the third party’s compensation and the double cost of medical insurance, deliberately defrauding the social medical insurance fund.
According to the prosecutor, in 2014, my country criminalized social security fraud, and those who defrauded social security were punished as fraud. According to the Interpretation of the Standing Committee of the National People’s Congress on Article 266 of the Criminal Law of the People’s Republic of China, fraud, forgery of certification materials or other means to defraud social insurance or other social security benefits such as pension, medical care, work-related injury, unemployment, maternity, etc. belongs to The act of defrauding public and private property as stipulated in Article 266 of the Criminal Law.
Li Youqi Ge Mingliang