Chinanews.com, October 28. According to the website of the Supreme People’s Court, the Supreme People’s Court announced on the 28th that 7 typical cases of people’s courts punishing medical insurance fraud crimes in accordance with the law, including fictitious medical expenses by "hanging an empty bed" and defrauding medical insurance funds ; Medical institutions inflated the amount of medicines by issuing "prescriptions and small prescriptions", and arbitrated the difference in medicines.
Case 1
Zeng Wangqing fraud case
—— Strictly punish the organizers and professional insurance fraudsters behind the medical insurance fraud in accordance with the law
(1) Basic case
The defendant Zeng Wangqing, male, Han nationality, was born on July 15, 1953.
In July 2017, the defendants Zeng Wangqing and Wang Ping (sentenced), Wan Xianwen (sentenced in another case), Tu Lizhi (sentenced), and Xiong Haizhen (sentenced) invited each other to share their responsibilities, and began to organize in Dawu County, Hubei Province Carry out criminal activities of using false medical information to defraud medical security funds.
From July 2017 to May 2019, Xiong Haizhen and Tu Lizhi alone or in conjunction with Hu Bing, Yin Bin, and Ying Qing (all sentenced) used medical insurance reimbursements, subsidies, etc. to borrow more than 70 local residents of medical insurance participants ID cards and rural commercial bank cards, through Wan Xianwen or directly provided to Zeng Wangqing, are used to forge medical insurance reimbursement materials such as false hospital records.
Tu Lizhi, Yin Bin, Hu Bing, Ying Qing, and Xiong Haizhen took the false hospitalization information provided by Zeng Wangqing to the Dawu County Medical Security Bureau and the Dawu Branch of China United Property Insurance Co., Ltd. for medical insurance settlement and critical illness insurance claims. Medical insurance funds and critical illness insurance are more than 1.025 million yuan, and the fraudulent proceeds are divided proportionally by all parties involved.
(2) Judgment results
The case was tried by the Dawu County People's Court of Hubei Province at the first instance and the Intermediate People's Court of Xiaogan City, Hubei Province at the second instance.
The court held that the defendant Zeng Wangqing used false hospitalization materials to obtain medical insurance funds for the purpose of illegal possession. The amount was extremely large, and his behavior constituted a crime of fraud.
Zeng Wangqing defrauded medical insurance funds and was severely punished as appropriate.
In the joint crime, Zeng Wangqing played the main role and was the principal offender.
Accordingly, Zeng Wangqing was sentenced to twelve years and six months in prison for fraud and a fine of 100,000 yuan.
(3) Typical meaning
In recent years, criminals have arbitrarily collected medical insurance information of insured persons in the name of hospitalization subsidies and low-cost medical care, forged false medical treatment and hospitalization medical records, and fraudulently obtained medical security funds. This has seriously damaged the healthy and sustainable development of the medical security system.
On April 24, 2014, the eighth meeting of the Standing Committee of the Twelfth National People’s Congress passed the "Interpretation on Article 266 of the Criminal Law of the People’s Republic of China", which clarified the fraudulent use of forged certification materials to obtain medical insurance. The case of gold belongs to the act of defrauding public and private property as stipulated in Article 266 of the Criminal Law.
The "Interpretation of the Supreme People's Court and the Supreme People's Procuratorate on Several Issues Concerning the Specific Application of Law in the Handling of Criminal Cases of Fraud" stipulates that fraudulent medical funds and materials shall be severely punished as appropriate.
In this case, the defendant Zeng Wangqing teamed up with others to form a professional insurance fraud gang to obtain medical security funds in an organized manner. Zeng Wangqing was an organizer who played a major role in the joint crime and should be severely punished in accordance with the law.
The sentence of this case not only reflects the spirit of severely punishing criminal organizers and professional fraudsters of medical insurance fraud, but also effectively safeguards the healthy and sustainable development of the medical security system.
Case 2
Fraud cases such as Jin Lijuan and Luo Anjun
——The designated medical insurance institution in the community defrauded the medical insurance fund by prescribing drugs falsely, and the amount was particularly huge
(1) Basic case
The defendant Jin Lijuan, female, Han nationality, was born on October 18, 1956.
The defendant Luo Anjun, female, Han nationality, was born on March 6, 1963.
(The status of other defendants is omitted)
The Community Health Service Station of Zhongli West District, Huangcun Town Station, Daxing District, Beijing, is a designated medical insurance institution of the city, funded by the defendant Jin Lijuan, and Jin Lijuan is the legal representative.
In 2011, Jin Lijuan and the defendant Luo Anjun, who was the head of the pharmacy of the health service station at the time, conspired to defraud the national medical insurance funds by prescribing drugs.
The latter two collected a large number of medical insurance cards through the employees of the unit, and according to the amount of medical insurance funds defrauded by the corresponding medical insurance cards, they were divided into the personnel who provided the medical insurance cards according to the proportion determined by Jin Lijuan.
Luo Anjun instructed the staff of the pharmacy to register and put drugs into the warehouse by means of false warehousing slips and inflated drug quantities.
At the same time, the pharmacy uniformly manages and deploys the collected medical insurance cards. According to the arrangement of Luo Anjun and others, the pharmacy staff regularly carry the collected medical insurance cards to the registration fee office, and the defendant Zhang Jingjing and others are registered, and then the general practitioner The defendant Zhang Jieqin and others issued false prescriptions, and then Zhang Jingjing and others made false payment, thereby defrauding medical insurance reimbursement.
Luo Anjun and others are also responsible for statistics and accounting of the use and profitability of each medical insurance card and report to Jin Lijuan.
The defendant, Fu Zhengrong, was the director and cashier of the Office of the Health Service Station, and at the same time assisted Luo Anjun in defrauding medical insurance funds in the pharmacy.
Defendant Wang Miao was a staff member of a pharmacy. Under the leadership of Luo Anjun and others, he participated in fraudulent activities such as falsely entering medicines, holding medical insurance cards for false registration, and paying fees.
The defendant Gao Jing was a nurse, and the defendant Ma Sanchun was an accountant. The two together with the other defendants collected medical insurance cards for the health service station to prescribe drugs for false use.
As of September 2017, Jin Lijuan defrauded more than 30 million yuan in medical insurance funds, Luo Anjun participated in defrauding more than 29 million yuan in medical insurance funds, Fu Zhengrong participated in defrauding more than 28 million yuan in medical insurance funds, Zhang Jieqin participated in defrauding more than 30 million yuan in medical insurance funds, and Ma Sanchun participated in defrauding more than 20 million yuan in medical insurance funds. Gao Jing participated in defrauding medical insurance funds of more than 30 million yuan, Zhang Jingjing participated in defrauding medical insurance funds of more than 23 million yuan, and Wang Miao participated in defrauding medical insurance funds of more than 27 million yuan.
In the first half of 2016, the defendant Jin Lijuan instructed Jin Lianhai to transfer the original vouchers and accounting vouchers that the health service station should keep in accordance with the law to the residence of his father in Donghuicheng Village, Qingyundian Town, Daxing District, causing the whereabouts of the above accounting vouchers to be unknown.
(2) Judgment results
The case was tried by the Beijing Second Intermediate People's Court for the first instance and the Beijing Higher People's Court for the second instance.
The court found that the defendants, Jin Lijuan and Luo Anjun, used methods such as falsely prescribing drugs to defraud the national medical insurance funds for the purpose of illegal possession.
As the person in charge of the health service station, Jin Lijuan deliberately concealed accounting vouchers that should be kept in accordance with the law. The circumstances were serious, and his behavior constituted the crime of concealing accounting vouchers.
Based on this, Jin Lijuan was sentenced to life imprisonment for fraud, deprivation of political rights for life, and all personal property confiscated. He was sentenced to three years imprisonment for the crime of concealing accounting documents and fined RMB 100,000. He decided to implement life imprisonment and deprivation. Political rights are for life, and all personal property is confiscated.
Luo Anjun was sentenced to 14 years in prison for fraud, deprived of political rights for three years, and fined RMB 140,000.
The other defendants were sentenced to three to eleven years in prison for the crime of fraud, with fines ranging from RMB 30,000 to RMB 110,000.
(3) Typical meaning
This case is a typical case in which designated medical insurance institutions in the community defrauded medical insurance funds by prescribing drugs falsely.
The defendant in this case, Jin Lijuan and others, used the community health service station they operated to premeditately collect a large number of medical insurance cards, used false warehousing orders, inflated the number of drugs, and other methods for drug registration and storage, and registered and issued medical insurance cards on a regular basis. Fake prescriptions, false payment, and then defraud medical insurance reimbursement, the behavior is highly concealed, the time span is as long as 7 years, the medical insurance fund fraudulently obtained up to more than 30 million yuan, causing huge losses to the medical insurance fund, and should be punished in accordance with the law.
In this case, Jin Lijuan was sentenced to life imprisonment, Luo Anjun was sentenced to 14 years imprisonment, and other defendants were sentenced to three to 11 years imprisonment, which fully reflects the spirit of severe punishment in accordance with the law, and warns designated medical insurance institutions in the community not to commit fraud. If the medical insurance fund commits a crime, otherwise it will be subject to criminal prosecution.
Case 3
Fraud case of Ma Liang and Guo Wanling
—— Fictitious medical expenses by "hanging an empty bed" to defraud medical security funds
(1) Basic case
Defendant Ma Liang, male, Han nationality, was born on December 14, 1982, a shareholder of Jiaxing Nanhu Jiacheng Nursing and Rehabilitation Hospital.
Defendant Guo Wanling, male, Han nationality, was born on September 24, 1955, the director of Jiaxing Nanhu Jiacheng Nursing and Rehabilitation Hospital.
In April 2015, Jiaxing Nanhu Jiacheng Nursing Home was established. The actual investors were the defendant Ma Liang and others, and the defendant Guo Wanling was the dean. In September 2015, the name was changed to Jiaxing Nanhu Jiacheng Nursing and Rehabilitation Hospital.
From October 2015 to January 2016, Ma Liang and Guo Wanling, in order to obtain illegal benefits, used the name of free physical examination and rehabilitation to attract elderly people with medical insurance cards to nursing homes for simple physical examination or directly use the elderly’s medical insurance without physical examination. The card went through the hospitalization procedures. When the elderly did not need to be hospitalized and were not actually hospitalized, they falsely prescribed more medicines, inspections, nursing and other expenses, defrauding medical insurance funds of more than 1.156 million yuan (of which more than 141,000 yuan has not been issued).
(2) Judgment results
The case was tried by the Nanhu District People's Court of Jiaxing City, Zhejiang Province, and the Intermediate People's Court of Jiaxing City, Zhejiang Province, for the second instance.
The court found that the defendants Ma Liang, Guo Wanling and others made up for the purpose of illegal possession, fabricated facts, formed a group to defraud the National Medical Insurance Fund, and their actions constituted the crime of fraud.
In a joint crime, Ma Liang is the principal offender; Guo Wanling plays a secondary and auxiliary role and is an accessory, and the punishment is mitigated in accordance with the law.
Accordingly, Ma Liang was sentenced to ten years in prison for fraud and a fine of RMB 150,000; Guo Wanling was sentenced to eight years in prison and a fine of RMB 100,000.
(3) Typical meaning
This case is a typical case in which a private hospital falsified medical expenses by "hanging an empty bed" and defrauding the medical security fund.
In recent years, a large amount of private capital has entered the medical industry, especially the rapid development of medical care and nursing hospitals for the elderly, but the quality of the development of the industry is uneven.
In order to obtain illegal benefits, some private medical institutions focus their attention on the elderly, taking advantage of the lack of awareness and lack of vigilance of the elderly to defraud medical security funds.
Defendants Ma Liang and Guo Wanling in this case, as shareholders and managers of the hospital, organized medical staff to attract and use the elderly to use medical insurance cards for false treatment, illegally embezzling a huge amount of national medical security funds, and seriously disrupting the development of the private medical industry, causing great social harm. Should be punished.
According to the criminal law, a unit cannot be the subject of the crime of fraud, but the person in charge of the unit, Ma Liang, and others can be held criminally responsible in accordance with the law.
The sentence of this case is conducive to protecting the safety of the medical security fund and promoting the healthy development of the private medical industry.
Case 4
Fraud case of Jin Ye, Zhang Chuan, Gao Feng, Tao Yuquan, Gu Cuixia
——Medical institutions inflated the amount of medicines by issuing "prescriptions and small prescriptions", and arbitrated the difference in medicines
(1) Basic case
The defendant Jin Ye, male, Han nationality, was born on April 10, 1979.
The defendant Tao Yuquan, male, Han nationality, was born on December 30, 1982.
Defendant Zhang Chuan, male, Han nationality, was born on November 28, 1981.
The defendant Gao Feng, male, Han nationality, was born on December 24, 1980.
Defendant Gu Cuixia, female, Han nationality, was born on June 26, 1959.
At the beginning of January 2017, the defendant Jin Ye, due to the fact that the Huai'an Renji Hospital operated and managed had fewer patients and poor economic benefits. After consulting with the defendant Tao Yuquan and others, it was decided to use the slogan "pay 100 yuan for hospitalization" to publicize and attract economic difficulties. Of patients are hospitalized.
Since then, Jin Ye instructed Tao Yuquan, Zhang Chuan, Gao Feng, and Gu Cuixia to prescribe large and small prescriptions for inpatients, and use the drugs on the small prescriptions that actually occurred for the treatment of the patients, and use the inflated prescriptions on the large prescriptions. Apply for reimbursement of the drug amount to the medical insurance agency, and collect the drug balance.
From January to November 2017, Jin Ye and others treated 364 inpatients who participated in medical insurance by the above methods, and defrauded more than 398,000 yuan in medical insurance funds.
The illegal income mentioned above is used after being occupied by the hospital, part of it is used to cover the hospitalization expenses of the patients, and part of it is used to pay staff salaries.
The defendant Jin Ye was notified by the police to surrender and notified the other four defendants to surrender according to the requirements of the police.
During the investigation and punishment of the law enforcement department of the Human Resources and Social Security Bureau, Jin Ye took the initiative to return the illegal income.
(2) Judgment results
The case was heard by the People's Court of Huaian District, Huaian City, Jiangsu Province.
After the judgment was pronounced, there was no appeal or protest within the statutory time limit, and the original judgment has become legally effective.
The court found that the five defendants, Jin Ye and Tao Yuquan, used fictitious facts and concealed the truth for the purpose of illegal possession, and defrauded the “New Rural Cooperative Medical Insurance” funds with forged certification materials. The amount was huge, and their actions constituted the crime of fraud.
The chief culprit of the gold leaf department.
Four persons including Tao Yuquan were accomplices, and their punishment was mitigated in accordance with the law.
Each of the five defendants had surrendered and could be punished lightly in accordance with the law.
Gold Leaf refunds all the illegal gains and can be given a lighter punishment.
Accordingly, Jin Ye was sentenced to three years’ imprisonment for fraud and four years of probation, and a fine of RMB 420,000; at the same time, Jin Ye was prohibited from engaging in private hospital management activities during the probation period; Tao Yuquan was sentenced to two years’ imprisonment. Years, three years of probation, and a fine of RMB 150,000; Zhang Chuan was sentenced to one year and nine months of imprisonment, two years and six months of probation, and a fine of RMB 100,000; the peak was sentenced to one year and six months of imprisonment , Suspended for two years, and fined RMB 80,000; sentenced Gu Cuixia to one-year imprisonment, suspended for one year and six months, and fined RMB 50,000.
(3) Typical meaning
This case is a typical case in which a medical institution treats patients with small prescriptions and inflates the amount of medicines with large prescriptions to defraud medical security funds.
Medical institutions shall strengthen industry self-discipline and self-discipline, regulate medical service behaviors, provide medical services in a reasonable and truthful manner, and truthfully issue expense receipts and related materials, and shall not collude medicines and diagnosis and treatment items.
In this case, the defendant Jin Ye, etc., in violation of the regulations, used the propaganda method of "pay 100 yuan to be hospitalized" to attract patients who participated in the "New Rural Cooperative Medical System". The act has constituted a crime of fraud and should be punished in accordance with the law.
The sentencing of this case reminded the insured personnel not to be greedy for small gains and freely provide medical insurance materials to others, so that criminals could take advantage of it; it also reminded the majority of medical workers to observe professional ethics and provide medical services in accordance with laws and regulations.
Case 5
Wang Tao's Corruption Case
——The staff of the Medical Insurance Bureau took advantage of their positions and resorted to methods such as false reports and false claims to cash out the national medical insurance funds
(1) Basic case
The defendant Wang Tao, male, Han nationality, was born on February 18, 1991, and was originally an employee of the Ezhou Medical Insurance Bureau.
From September 2017 to November 2018, while working at the window of the Ezhou Medical Insurance Bureau, the defendant Wang Tao used the convenience of being responsible for medical insurance fund reimbursement review and payment confirmation, and successively inquired 42 patients in the medical insurance system of the Municipal Medical Insurance Bureau (times) ) After reimbursing hospitalized medical expenses information, use the online banking USB shield and password of a colleague to enter the medical insurance bureau's intranet system without authorization, re-enter the above-mentioned patient hospitalized medical information, and then use the authority to review reimbursement data to approve and review the reimbursed reimbursement information With payment confirmation, more than 1.321 million yuan of medical insurance fund was acquired.
From September to October 2018, the defendant Wang Tao took advantage of the above-mentioned position and inquired in the medical insurance system of the Municipal Medical Insurance Bureau to find relevant information about 6 patients (times) who are eligible for reimbursement of special drug expenses for chronic disease outpatient clinics, and then fictitiously made up the 6 people (times). For information on reimbursement of special medicines for critically ill chronic disease outpatient clinics, use the online banking USB shield and password of a colleague to enter the internal network system of the Medical Insurance Bureau without authorization, enter the above information, and then use the authority to review the reimbursement data to review the above falsely entered reimbursement information and confirm the payment , Arbitrage medical insurance fund of more than 380,000 yuan.
The defendant Wang Tao used the medical insurance fund obtained above for online gambling and repaying credit card overdrafts due to online gambling.
Later Wang Tao surrendered to the public security organs.
(2) Judgment results
The case was heard by the People's Court of Echeng District, Ezhou City, Hubei Province.
After the judgment was pronounced, there was no appeal or protest within the statutory time limit, and the original judgment has become legally effective.
The court found that the defendant Wang Tao, as a state worker, used the convenience of his position and resorted to false reports and false claims to cash out the National Medical Insurance Fund for illegal activities. The circumstances were particularly serious and his actions constituted a crime of corruption.
Wang Tao had the plot to surrender and pleaded guilty in court, which can be mitigated.
Accordingly, Wang Tao was sentenced to six years and six months in prison for corruption and a fine of RMB 500,000.
(3) Typical meaning
This case is a typical case of the staff of the Medical Insurance Bureau taking advantage of their positions to embezzle the medical security fund.
As a staff member of the Ezhou Medical Insurance Bureau, the defendant Wang Tao in the case used the convenience of being responsible for the medical insurance fund review and reimbursement, payment confirmation and other duties to reimburse the hospitalized medical expenses reimbursed by others or fabricate the medical expenses of others. Reimbursement, arbitrage of the National Medical Security Fund, and the use of the illicit money in illegal activities. The circumstances are particularly serious and are convicted and punished for corruption in accordance with the law.
The sentence in this case warned state personnel engaged in work related to the medical security fund to perform their duties in accordance with the law, exercise their power prudently, and maintain the safety of the medical security fund.
Case 6
Zhao Desheng fraud case
——Insured persons defrauded the medical insurance fund by buying drugs in excess and reselling them
(1) Basic case
The defendant Zhao Desheng, male, Han nationality, was born on December 18, 1953.
From 2014 to June 2020, defendant Zhao Desheng used his own medical insurance card to prescribe more and falsely prescribe drugs at Huzhou Central Hospital, Changxing County People’s Hospital and other medical institutions in order to resell drugs for profit. Li Mingsong and others defrauded the National Medical Insurance Fund of at least 494,000 yuan.
On November 15, 2016, Zhao Desheng’s medical insurance fraud was discovered by the Huzhou Social Security Bureau and ordered to return the medical insurance losses. As of August 2018, Zhao Desheng had returned more than 163,000 yuan.
Zhao Desheng did not stop after being punished, and continued to commit the crime until the incident occurred.
In addition, the defendant Zhao Desheng did not suffer from hepatitis B, Alzheimer's disease, Parkinson's disease, or mental illness.
After checking the flow of Zhao Desheng's personal health insurance card, from 2014 to June 2020, Zhao Desheng prescribed drugs for hepatitis B, Alzheimer's disease, Parkinson's, and mental diseases, with a value of more than 79,000 yuan.
(2) Judgment results
The case was heard by the People's Court of Changxing County, Zhejiang Province.
After the judgment was pronounced, there was no appeal or protest within the statutory time limit, and the original judgment has become legally effective.
The court held that the defendant Zhao Desheng defrauded the National Medical Insurance Fund by falsifying facts and concealing the truth for the purpose of illegal possession. The amount was huge, and his behavior constituted a crime of fraud.
After Zhao Desheng returned to the case, he truthfully confessed the facts of the crime, which has a frank plot and can be given a lighter punishment in accordance with the law.
Accordingly, Zhao Desheng was sentenced to four years and six months in prison for fraud and a fine of RMB 50,000.
(3) Typical meaning
This case is a typical case where the insured persons used the medical insurance benefits they enjoyed to purchase drugs in excess and then resell them for profit.
Participants shall not take advantage of the opportunity of enjoying medical insurance treatment to resell drugs, accept the return of cash, in kind, or obtain other illegal benefits.
If the insured person commits the aforementioned actions, the medical security administrative department may suspend its online settlement of medical expenses for 3 to 12 months; if the aforementioned actions are implemented for the purpose of defrauding the medical security fund and cause the loss of the medical security fund, the medical security administrative department A fine of more than 2 times and less than 5 times the amount obtained by fraud shall be imposed; if the amount reaches the standard of a larger amount and violates the criminal law, criminal responsibility shall be investigated for the crime of fraud.
In this case, the defendant Zhao Desheng was an insured person. For the purpose of profit, he used the opportunity of enjoying medical insurance treatment to purchase and resell medical insurance drugs in excess, causing losses to the National Medical Insurance Fund. The amount was huge. His behavior has constituted a crime of fraud and should be punished in accordance with the law.
The sentence of this case is conducive to maintaining the safety of the medical security fund, and it has also sounded the alarm for the insured persons to use medical security benefits in violation of laws and regulations.
Case 7
Liu Zhipu Fraud
——Insured persons repeatedly reimburse medical expenses and defraud medical insurance funds
(1) Basic case
The defendant Liu Zhipu, male, Han nationality, was born on November 14, 1957.
From December 2014 to August 2016, the defendant Liu Zhipu was admitted to Shanghai Hospital and Anhui Provincial Hospital respectively due to liver disease. The medical expenses incurred by his inpatients were reported through the Linquan County Urban and Rural Basic Medical Insurance Management Center.
Knowing that his medical expenses have been reimbursed, Liu Zhipu still used forged medical bills to repeatedly reimburse medical expenses. He reported his medical expenses through the Linquan County Medical Insurance Fund Management Center six times to obtain medical insurance by fraud. More than 99,000 yuan in gold.
On December 25, 2016, Liu Zhipu's close relatives refunded the medical insurance money he fraudulently obtained to Linquan County Medical Insurance Fund Management Center.
(2) Judgment results
The case was heard by the People's Court of Linquan County, Anhui Province.
After the judgment was pronounced, there was no appeal or protest within the statutory time limit, and the original judgment has become legally effective.
The court held that the defendant Liu Zhipu fictionalized facts, concealed the truth, and defrauded medical insurance funds for the purpose of illegal possession. The amount was huge, and his behavior constituted a crime of fraud.
Liu Zhipu was summoned to the case by the public security organs, truthfully confessed his crimes, and voluntarily pleaded guilty in court. He surrendered himself, and the punishment could be mitigated in accordance with the law.
Actively withdraw the stolen money, and can be given a lighter punishment as appropriate.
According to this, Liu Zhipu was sentenced to two years’ imprisonment for fraud, suspended for three years, and fined 10,000 yuan.
(3) Typical meaning
This case is a typical case of repeated reimbursement of medical expenses by insured persons.
As the current medical insurance system is still being improved, the three major medical systems, including urban employee medical insurance, urban residents medical insurance, and new rural cooperative medical care, are disconnected, and unified management has not been realized. Some insured persons repeatedly reimburse medical expenses and fraudulently obtain medical insurance. Fund cases happen from time to time.
In this case, the defendant Liu Zhipu’s inpatient medical expenses have been reimbursed through the urban and rural basic medical insurance management center, and the method of forged medical bills is still used to repeatedly reimburse medical expenses, defrauding the medical security fund, the amount is huge, and the behavior has constituted a crime of fraud.
The sentence of this case reminded the majority of insured persons not to be greedy for small gains and to try the law by themselves. It also lit a red light and sounded the alarm for the perpetrators of repeated reimbursements to defraud medical security funds.