What are the behaviors of medical insurance fraud?

Legal analysis: 1, allowing or inducing uninsured individuals to be hospitalized in the name of the insured. 2. The medical expenses paid by the insured person at his own expense shall be declared and paid to the medical insurance fund. 3, hanging bed in the hospital or will be able to outpatient treatment of insured individuals admitted to hospital. 4, the insured individuals use repeated registration, repeated or no indication of treatment, decomposition of hospitalization and other means of transitional medical care or provide unnecessary medical services. 5, in violation of the provisions of the scope of medical insurance drugs or drug varieties, excessive use, repeated use, illegal use of drugs with special restrictions, or self decomposition, change the prescription, etc. Dispensing medicines for the insured. 6 expenses incurred by non-designated medical institutions shall be incorporated into the expenses of designated medical institutions and settled with medical insurance agencies. 7, to assist the insured person to bear the medical insurance personal account fund or overall fund. 8. Illegal charging behaviors such as raising charging standards, increasing charging items, decomposing charging items, repeating charging, and expanding charging scope without authorization. 9, fraud, false data, etc. Access to medical insurance funds or personal account funds. 10, selling drugs for non-designated drug business units and swiping social security cards on their behalf. 1 1. Change the expenses of drugs, diagnosis and treatment items, medical materials, medical service facilities or daily necessities, health supplements, etc. beyond the scope of medical insurance payment into expenses within the scope of medical insurance policy, apply for medical insurance settlement, and collect funds to pay. 12, forging or using false medical records, prescriptions, inspection reports, disease diagnosis certificates and other medical documents to defraud the medical insurance fund. 13, using false medical bills for reimbursement. 14, other acts that violate the relevant provisions of social insurance and cause losses to the medical insurance fund.

Legal basis: Article 198 of the Criminal Law of People's Republic of China (PRC) commits insurance fraud under any of the following circumstances, and if the amount is relatively large, it shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention, and shall also be fined not less than 10,000 yuan but not more than 100,000 yuan; If the amount is huge or there are other serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than five years but not more than ten years, and shall also be fined not less than 20,000 yuan but not more than 200,000 yuan; If the amount is especially huge or there are other especially serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 10 years, and shall also be fined not less than 20,000 yuan but not more than 200,000 yuan, or his property shall be confiscated:

(1) The applicant intentionally fabricates the subject matter of insurance to defraud the insurance money;

(2) The applicant, the insured or the beneficiary fabricates false reasons or exaggerates the loss of the insured accident to defraud the insurance money.

(3) The applicant, the insured or the beneficiary fabricates an insurance accident that has never happened to defraud the insurance money;

(4) The applicant or the insured intentionally causes an insurance accident that causes property losses and defrauds the insurance money;

(5) The applicant or beneficiary intentionally causes the death, disability or illness of the insured to defraud the insurance money.

Whoever commits the acts listed in Items 4 and 5 of the preceding paragraph, which constitutes other crimes, shall be punished in accordance with the provisions of combined punishment for several crimes. Retrieve the report. If a unit commits the crime mentioned in the first paragraph, it shall be fined, and the directly responsible person in charge and other directly responsible personnel shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention; If the amount is huge or there are other serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than five years but not more than ten years; If the amount is especially huge or there are other especially serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 10 years. Search report