How to operate and realize medical insurance card fraud?

The common methods of medical insurance card fraud operation are as follows:

First of all, fraudsters may obtain medical insurance card information through illegal means. They may cheat individuals' medical insurance card numbers, passwords and identity information through phishing, malware and impersonation of official institutions.

Secondly, fraudsters may use the stolen medical insurance card information for illegal operations. They may pretend to be cardholders, handle medical insurance business in hospitals or pharmacies, get medical services or buy medicines. These operations may involve false reimbursement, repeated reimbursement, drug purchasing and other means to obtain illegal benefits.

In addition, fraudsters may also collude with internal personnel of medical institutions to defraud medical insurance cards through fictitious medical records and false medical expenses. It is possible to falsify medical records and fabricate diagnosis results in order to obtain higher medical insurance reimbursement.

Fraudsters may also cheat medical insurance cards through fictitious medical services, such as fake surgery and fake treatment. They may collude with doctors and pharmacies to provide false medical services to obtain medical insurance reimbursement.

Attention should be paid to the use of medical insurance cards:

1. Cash withdrawal is prohibited.

No unit or individual may violate the scope and requirements of the medical insurance card, and it is strictly forbidden to take cash.

2. Some provincial and municipal medical insurance cards can be used by the whole family.

In some provinces and cities, such as Zhejiang Province and Guangzhou City, the surplus funds in personal accounts of medical insurance over the years can be used to pay the medical insurance expenses of the spouses, children, parents and other close relatives of employees' basic medical insurance participants, so as to realize mutual assistance among family members.

3. The following medical insurance will not be paid.

Seeing a doctor in a non-designated medical institution or buying medicine in a non-designated retail pharmacy (except emergency): self-injury caused by personal fighting, drug abuse or other illegal acts; Treatment for alcoholism, suicide and self-mutilation; Injuries caused by traffic accidents, medical accidents or other liability accidents; And the situation that the state or local regulations should be paid by individuals.

To sum up, medical insurance card fraud is a serious crime, which needs the joint efforts of individuals and all walks of life to prevent and combat.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 12

The basic medical insurance premium is levied on a monthly basis, and the employer and employees shall pay the basic medical insurance premium to the tax collection authority within the prescribed time limit. The part that individual employees should pay shall be withheld and remitted by the employer from their wages.