Cure protects conversational forum (the 11st period)
Theme: "Two calm " the behavior of medical treatment service of the orgnaization is superintended
Place: Liaoning Shenyang
Attention
The medical treatment of broad sense is sure to include insurance of social medical treatment and insurance of commercial medical treatment, the medical treatment of narrow sense is sure to show social medical treatment is safe, namely we are weighed daily " cure is protected " , namely the subject that the article discusses. The social member that the purpose with safe society is the unemployment in be a society, circumstance such as aged, disease provides the basiccest material safeguard, social medical treatment is sure to producing main effect to solving problem of the people's livelihood. But carry out further as what social medical treatment is sure, bilk cure protects the case of fund to happen ceaselessly, certain person passes make out an invoice of cheat of cheat of case of illness, sickbed of be in hospital, empty to take cure to keep fund according to waiting for all sorts of means to cover for expedience, cause insurance fund a large number of prediction of a person's luck in a given year.
Medical treatment is safe and con with punish of crime of fraud,
Involve civil liability, administration liability at the same time
Our country was not aimed at the law with safe and con medical treatment technically, involve medical treatment the regulation related responsibility of safe and con law comes loose see in many law laws and regulations.
1
Criminal responsibility
Our country " criminal law " although not was aimed at the accusation with safe and con medical treatment clearly, but standing committee of countrywide National People's Congress is newest on April 24, 2014 the criminal law explanation that carry is clear: With con, falsify proof data provide for the aged of diddle of other perhaps measure, medical treatment, inductrial injury, unemployed, bear wait for social insurance gold of pay of other perhaps social security, belong to the bilk that criminal law sets the 266th times the behavior of state-private property. Basis " criminal law " the 266th regulation, bilk is state-private property, the part with larger number battle of 3 years of the following set term of imprisonments, arrest or control, be in or only punishment gold; Amount is huge perhaps have other and serious plot, be in 3 years of above 10 years the following set term of imprisonment, punish gold; Amount is particularly huge perhaps have other and special serious plot, be in set term of imprisonment of 10 years of above or life imprisonment, punish gold to perhaps confiscate property. Be sure to medical treatment in judicatory practice at present also is false maintain with crime of fraud: On June 16, 2017, city of Anqing of the Anhui province greets careful of court of river area people to written guarantee bilk medical treatment is sure one case golden case, part with crime of fraud to Zhang Mou of the accused person some sentences a set term of imprisonment one year 4 months, probation 2 years, punish golden RMB 12 thousand yuan of; are right the accused person old Liu is such-and-such, such-and-such respectively RMB of only punishment gold 8000 yuan, 6000 yuan.
2
Civil liability
" civil code general rule " fiftieth 8 regulations, one party makes with fraudulent means the other side issues is civil action to disable in the condition that violates true meaning. The 117th sets, of embezzlement country, collective belongings or of other belongings, ought to return return property, cannot return those who return property, ought to compensation of convert into money. According to afore-mentioned regulations, fraudulent action person uses fraudulent means to get medical treatment safe and relevant loaves and fishes, its behavior from only then without legal effectiveness, must return return administration of fund of medical treatment insurance.
" contract law " the 19th regulation, party is colluded with because of ill will, damage country, collective or interest of the 3rd person and taking property receives homecoming home all perhaps return collective still, the 3rd person. According to this regulation, individual or unit and orgnaization of agency of medical treatment insurance or service of medical treatment insurance offer an orgnaization to conspire insurance fund should return the medical treatment of diddle to still give medical treatment orgnaization of insurance fund agency.
3
Administrative responsibility
" social insurance law " the 87th regulation, the orgnaization of social insurance service such as management unit of orgnaization of social insurance agency and medical establishment, drug with con, falsify proof data of expenses of fund of insurance of society of diddle of other perhaps measure, the social insurance gold that instructs go back diddle by social insurance service, duple above fines place diddle amount below fivefold; Belong to a society to be sure to serve an orgnaization, remove service agreement; The director staff that is in charge of directly and personnel of other and direct responsibility have hold of job seniority, lawfully revoke its hold job seniority. The 88th sets, with con, falsify proof data of pay of insurance of society of diddle of other perhaps measure, the social insurance gold that instructs go back diddle by social insurance service, duple above fines place diddle amount below fivefold.
According to afore-mentioned regulations, individual or relevant orgnaization should be sure the medical treatment of diddle fund is returned return administration of fund of medical treatment insurance.
Since criminal law explanation was promulgated 2014, cure is protected cheat protect punishment to already was made clear in legislation and judicatory domain, but a few public do not understand this, thinking oneself is the petty gain that have an insatiable desire for a dot only just, the deed that does not realize oneself may have offended law, make crime even.
Medical treatment is safe and con in the principal part that involves possibly and means
1
Cast protect obligor or legal beneficiary beneficiary
Medical treatment is sure to cast protect obligor, it is the unit that shows to medical treatment insurance assumes capture to expend obligation and individual; Medical treatment is safe and legal beneficiary beneficiary, it is to point to the individual that can be sure to acquire an interest from medical treatment lawfully, include medical treatment to be sure to be reached by policy-holder its are close relative. Medical treatment is sure to cast protecting obligor and legal beneficiary beneficiary is medical treatment insurance is the mainest with the directest interest relative, fraudulent action basically includes: Lend, risk maintain calorie of seek medical advice with cure; Forge, empty opens remedial expense voucher to submit an expense account; Violate compasses or excessive open medicine and resell.
2
Orgnaization of agency of insurance of social medical treatment.
Reach its staff member
Orgnaization of agency of insurance of social medical treatment is fund of insurance of medical treatment of society of the director in pointing to the moving process in system of insurance of whole society medical treatment raise money, management, pay, supervise the orgnaization that waits for the job. The fraudulent action of agency orgnaization and staff member basically includes: Issue truthless proof data, make cannot join the personnel ginseng that protect to protect diddle of harmonious perhaps individual originally primary medical treatment ensures treatment; Bill cheat; Anamnesis cheat.
3
Social medical treatment is sure to serve an orgnaization
Reach its staff member to carry out
Social medical treatment is safe and con behavior
Orgnaization of service of insurance of social medical treatment is the orgnaization that obtains relevant accredit to offer the medical treatment related to insurance of social medical treatment to serve thereby below the commission of orgnaization of agency of medical treatment insurance, the service that is insurance of social medical treatment is offerred square. Include to nod hospital and calm dot drugstore surely. Nod the fraudulent action of the hospital to basically include surely: Empty drives cost of go to a doctor; Falsify record of be in hospital; The disease that excessive cure makes can be cured originally divides cure; Unreasonable cure; Use ginseng protects person information to cover insurance cost showing medical service to use; Defend blame medical service medical service of disbursement project seize instead to maintain paying project; Turn receive terminal of settle accounts of informatization of medical treatment charge to give other unit and individual. Nod the fraudulent action of drugstore to basically include surely: Do not check prescription and cure intentionally to keep card; The drug that keeps range intentionally with blame cure replaces cure to keep the drug of limits; Truthless type ginseng protect a person to buy medical information; Protect card to change cash to wait with cure. In January 2017, bureau of company of person of peaceful wave city is reported, a few days ago, baoding of two medical service of peaceful wave city selects 5 staff members of medical establishment, because bilk cure keeps fund, be found out lawfully criminal responsibility.
4
Bilk gang
Gang of bilk of fund of medical treatment insurance basically is the division of labor through having an organization insurance fund is a purpose and be engaged in medical treatment technically with detinue medical treatment the guilty gang of safe and fraudulent action. The fraudulent action of bilk gang basically includes: Cure of illegal buy in and sell at a profit keeps drug; Wait for a variety of form prevail on to join cure of the lend that keep a person to keep card through advertisement, lecture with all sorts of conditions and interest; Risk with other cure the go to a doctor that keep card opens medicine; The collude doctor, hospital that decide a dot, issue anamnesis, be in hospital illegally to prove to wait; Collude with cure Baoding to nod drugstore, for its large quantities of quantities use other cure to protect calorie of give the green light to wait.
Afore-mentioned behavior cannot are, the likelihood makes crime, "Corrupt petty gain eats to have a deficit greatly " , do not let " ignorant " send oneself into the jail.
Heat is recommended
