The Supreme People's Court, the Supreme People's Procuratorate, and the Ministry of Public Security jointly held a press conference today to issue the "Guiding Opinions on Several Issues Concerning the Handling of Criminal Cases of Medical Insurance Fraud", further clarifying the conviction and punishment, application of law, policy understanding, and case handling requirements for the crime of medical insurance fraud. and related issues such as work systems and mechanisms.
Accurately identify the crime of medical insurance fraud
The medical insurance fund is the people's "medical treatment money" and "life-saving money". It is related to the vital interests of the broad masses, to the healthy and sustainable development of the medical security system, and to the long-term stability of the country.
"The crime of medical insurance fraud seriously endangers the security of medical insurance funds and damages the legitimate rights and interests of the people in medical security." Chen Hongxiang, president of the Third Criminal Tribunal of the Supreme People's Court, said that in order to punish the crime of medical insurance fraud in accordance with the law, safeguard the safety of medical security funds, and safeguard the people's medical security Regarding legitimate rights and interests, the Supreme People's Court, together with the Supreme People's Procuratorate and the Ministry of Public Security, drafted and formulated the "Guiding Opinions" based on in-depth research and full demonstration.
According to incomplete statistics, from 2021 to 2023, courts across the country concluded a total of 1,213 criminal cases of medical insurance fraud in the first instance, including: 306 cases concluded in 2021, 407 cases concluded in 2022, and 500 cases concluded in 2023, with year-on-year increases of 102.65% and 33.01 respectively. %, 22.85%, the number of cases is increasing year by year and the increase is relatively large.
Chen Xueyong, deputy director of the Third Criminal Tribunal of the Supreme People's Court, said: "The crime of medical insurance fraud involves many common crimes such as fraud, cover-up, concealment of criminal proceeds, corruption and other crimes, of which fraud accounts for 93.65%. The criminal subjects of medical insurance fraud include targeted Medical institutions and their personnel, designated retail pharmacies and their personnel, insured persons and their close relatives, professional insurance fraud gangs and other persons, and some cases also involve pharmaceutical manufacturers. Among them, insured persons accounted for 54.08% of the cases."
The "Guiding Opinions" are divided into 5 parts, with a total of 26 articles.
Clarify the scope of criminal cases of medical insurance fraud and medical security funds, the behavior of medical security agencies, designated medical institutions, insured persons and other individuals to defraud medical security funds and the conviction and punishment of related crimes, as well as the medical security administrative departments and The handling agency staff took advantage of their positions to defraud the medical security fund and were convicted and punished to ensure accurate identification of the crime.
At the same time as the "Guiding Opinions" were released, the two top authorities released 8 typical cases of punishing the crime of medical insurance fraud in accordance with the law, namely: the fraud cases of Liu A, Liu B, and Liu C, the fraud cases of Ma Yu, the fraud cases of Chen Mei, Cases of fraud, cover-up and concealment of criminal proceeds by Chen Mouying and Sun Mouyu, fraud cases by Gao Mou, fraud cases by Hu Mouliang and Zhang Mouhong, fraud cases by Xu Moulin, corruption cases by Zhao Ze and Zhao, corruption cases by Yang Mouxia case.
"The criminal subjects in these cases include designated medical institutions and their staff, pharmaceutical company representatives, insured persons, 'drug dealers' who resell medical insurance drugs, and state staff. The defendant in Case 3, Sun Mouyu, illegally resold and used medical insurance to defraud The defendant in Case 4, Gao, is a medical representative of a pharmaceutical company, the defendant in Case 5, Hu Mouliang, is an insured person, and the defendants in Case 7, Zhao Ze and Zhao, are from designated hospitals. Dean." Chen Hongxiang said.
Punish the crime of medical insurance fraud in accordance with the law
The "Guiding Opinions" require that crimes related to medical insurance fraud be severely punished in accordance with the law, focusing on cracking down on behind-the-scene organizers and professional insurance fraudsters, etc., clarifying the circumstances of severe and lenient punishment, strengthening the entire chain of punishment of crimes related to medical insurance fraud, and increasing Strengthen the intensity of property penalties, standardize the application of fine penalties, strictly control the application of suspended sentences, unify legal application standards and judicial judgment standards, and ensure the unity of the "three effects".
"In 2023, procuratorial organs across the country approved the arrest of 1,619 people in 1,054 cases of fraud and insurance fraud in various medical insurance fields, and initiated public prosecutions of 3,988 people in 2,037 cases." Cao Honghong, deputy director of the First Procuratorate of the Supreme People's Procuratorate, told reporters that innovating through big data supervision models In terms of digging into criminal clues, procuratorial organs at all levels have stepped up their research, judgment and supervision of major clues, supervising the filing of 546 cases involving 893 people.
Through data modeling, integrated review, and case-like supervision, the transformation from case handling to case-like supervision has been achieved, and dozens of projects such as "special disease drugs", "abnormal personnel seeking medical treatment", "empty medical insurance pooling fund accounts", etc. have been explored and developed. A digital supervision model for medical insurance fund fraud cases to accurately detect and crack down on various types of crimes that infringe on medical insurance funds.
In terms of implementing "grasping the front end and treating the disease before it occurs", the procuratorate promptly reviewed the clues transferred by the Medical Insurance Bureau and required the Medical Insurance Bureau to transfer the case to the public security agency.
The people's courts have effectively extended their judicial functions, formulated and issued targeted judicial suggestions on problems in the supervision and use of medical insurance funds discovered in the trial of medical insurance fraud cases, put forward opinions and suggestions, and promoted the governance of social litigation sources and systemic governance.
At the same time, typical cases were released to publicize to the public the methods and harmfulness of "reflux drugs" insurance fraud crimes, and achieved good results of "handling one case and managing one".
Chen Xueyong said: "We have always insisted on severely punishing the crime of medical insurance fraud in accordance with the law, focusing on cracking down on the organizers behind the scenes, professional insurance fraud people and organizations, and the ringleaders leading criminal groups, etc. Those who should be severely sentenced will resolutely be sentenced severely in accordance with the law. At the same time, we will effectively implement The criminal policy of combining leniency with severity and the leniency system for guilty pleas and punishments strive to achieve the best political, legal and social effects. The Supreme People's Court will supervise the handling of a number of major cases, strengthen supervision and guidance, and ensure the effectiveness of case handling."
Establish and improve coordination mechanism
The "Guiding Opinions" strengthen the collection, review and judgment of evidence in criminal cases of medical insurance fraud by the public security, procuratorate and courts, clarify the probative effect of evidence collected by the medical security administrative department in criminal proceedings, and the investigation and evidence collection of property involved in the crime of medical insurance fraud. , recovery of stolen goods and losses, etc., to ensure that the losses of medical security funds are minimized and the interests of the people are safeguarded to the greatest extent.
At the press conference, Chen Shiqu, deputy director of the Criminal Investigation Bureau and first-level inspector of the Ministry of Public Security, said that in 2023, public security agencies across the country will implement the deployment requirements of the Party Central Committee and the State Council, continue to carry out special rectification operations to combat insurance fraud, and jointly detect medical insurance fraud cases. In 2179 cases, 6220 criminal suspects were arrested, 346 criminal gangs were eliminated, and 263 illegal medical institutions were transferred to the medical insurance department for investigation and punishment.
According to reports, the "Guiding Opinions" establish and improve a coordination and cooperation mechanism.
Standardize and improve the execution connection mechanism, and establish and improve collaborative case-handling mechanisms such as preliminary investigation, case filing and investigation, review and prosecution, and trial execution.
Strengthen the active performance of the duties of the public security, procuratorate, and courts, make full use of the "three letters and one letter" to assist in the systematic governance and source control of illegal crimes of medical insurance fraud, and improve the long-term mechanism to prevent illegal crimes of medical insurance fraud.
Chen Shiqu said that in 2024, the Ministry of Public Security will take the implementation of the "Guiding Opinions" as an opportunity to organize public security agencies across the country to strengthen study, publicity and implementation, continue to increase efforts to crack down on medical insurance fraud crimes, and resolutely safeguard the safety of medical insurance funds and the people's medical insurance rights and interests.
We will further promote special crackdowns and rectification operations, adhere to zero tolerance for medical insurance fraud crimes, and maintain a high-pressure and crackdown posture.
Strengthen the application of the "Guiding Opinions", cooperate with the two top governments and regulatory authorities such as medical insurance and health care to strengthen supervision and guidance, and improve the ability to combat and prevent medical insurance fraud crimes.
Strengthen publicity and guidance, timely expose typical cases and criminal methods, deter criminals who commit medical insurance fraud, and educate and guide the public to use medical insurance rights in accordance with the law.
"We will strengthen communication, coordination and cooperation with the public security, procuratorial, medical insurance, health and other departments, improve the working mechanism, strengthen the connection between executions, and form a strong joint force to ensure effective crackdowns and powerful punishments. The Supreme People's Court will work with relevant departments to launch medical insurance funds Use special rectification work on violations of laws and regulations to continue to deepen the rectification of medical insurance fraud issues and ensure that the special rectification work achieves effective results." Chen Xueyong said.
Report from our reporter in Beijing on March 1st: Zhang Chen