Medical insurance fraud and the influence of medical insurance guarantor

Legal analysis: 1. It will be included in the "blacklist" and will be jointly punished across regions, fields and departments. According to Article 5 of the Interim Measures for the Administration of the List of Serious Untrustworthy Persons in the Field of Social Insurance issued and implemented by Ministry of Human Resources and Social Security on October 28th, 20 19, local human resources and social security departments at or above the county level shall include them in the list of serious untrustworthy persons in social insurance under any of the following circumstances:

(a) the employer fails to register social insurance according to law and refuses to correct it after administrative punishment; (two) to participate in social insurance in violation of regulations by means of fraud, forgery and other means, and to handle social insurance business for more than 20 times in violation of regulations or to profit more than 20 thousand yuan from it; (3) defrauding social insurance benefits or social insurance fund expenditures by fraud, forgery of certification materials or other means, with an amount of more than 1000 yuan, or refusing to return it after being ordered to return it; (4) after the recipients of social insurance benefits lose their eligibility for benefits, they voluntarily or overpay social insurance benefits for more than 6 months or the amount exceeds 1000 yuan. But refuses to return after being ordered to return, or fails to perform on time after signing the repayment agreement (5) maliciously uses the social insurance personal rights record for purposes other than those agreed with the social insurance agency, or discloses the social insurance personal rights information; (6) The social insurance service agency failed to provide services according to the service agreement, resulting in a fund loss of more than 65,438+10,000 yuan; (seven) the employer and its legal representative or the third party shall repay the industrial injury insurance benefits paid in advance by the social insurance fund according to law, and refuse to repay those who have the ability to repay; And (8) other circumstances that exceed 654.38 million yuan as stipulated by laws, regulations and rules.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 87 If social insurance agencies, medical institutions, pharmaceutical trading units and other social insurance service institutions defraud social insurance fund expenditures by means of fraud or forgery of certification materials, the social insurance administrative department shall order them to return the defrauded social insurance money, and impose a fine of not less than 2 times but not more than 5 times the amount defrauded. If the service agreement is terminated and the responsible person in charge and other directly responsible personnel have the qualification to practice, their qualification to practice shall be revoked according to law.

Article 88 Anyone who defrauds social insurance benefits by fraud, forgery of certification materials or other means shall be ordered by the social insurance administrative department to return the defrauded social insurance benefits, and shall be fined at least two times but not more than five times the amount defrauded.