Fraudulent insurance means that the insured defrauds the illegitimate interests of the insurance company, which is illegal regardless of whether the claim is successful or not (insurance law, contract law, etc.). ), the insurance company will decide whether to pursue responsibility according to the seriousness of the case. Serious will lead to judicial intervention.
It is an illegal and criminal act of defrauding medical insurance funds, which may constitute fraud. Fraud refers to the act of defrauding a large amount of public and private property by fabricating facts or concealing the truth for the purpose of illegal possession. It's obviously a work injury. It is a typical fraud to reimburse agricultural insurance. In addition to recovering the reimbursement, in addition to defrauding the amount, a fine of 2-5 times will be imposed; If a crime is constituted, criminal responsibility shall be investigated according to law.
Insurance fraud, which does not constitute a crime, shall be given administrative punishment according to law:
(1) The applicant intentionally fabricates the subject matter of insurance to defraud the insurance money;
(2) fabricating an insurance accident that never happened, or fabricating a false cause of the accident, exaggerating the degree of loss, and defrauding insurance money;
(3) Deliberately causing an insurance accident and defrauding insurance money.
Where an appraiser, appraiser or witness of an insurance accident intentionally provides false documents to provide conditions for the applicant, the insured or the beneficiary to commit insurance fraud, he shall be punished in accordance with the provisions of the preceding paragraph.
I hope the above content can help you. Please consult a professional lawyer if you have any other questions.
Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), the following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.