Is it illegal to reimburse with family medical insurance card? Recently, the case of "a mother asked her daughter to buy medicine with her father's medical insurance card, and both mother and daughter were sentenced" in Zhejiang was reported by the media, which aroused widespread concern in society. Many Xi citizens exclaimed: Do you dare to buy medicine with your family's medical insurance card in the future? Is it the same as ordinary citizens who often go to pharmacies to buy medicine? Yesterday, the reporter interviewed the Xi Municipal Bureau of Human Resources and Social Security to explain the specific use of the medical insurance card for you. The reporter who sentenced the mother and daughter to fraudulently use the medical insurance card found that in the report of this case, the mother asked her daughter to brush her father's medical insurance card, not only the money in the medical insurance card, but also the reimbursement. In the later communication process, many people took it out of context and spread it to the personal account where the mother asked her daughter to swipe her father's medical insurance card. According to the initial report, 75-year-old Zou suffered from high blood pressure and asked her daughter to use her father's medical insurance card 34 times. Later, she reimbursed the medical expenses 1 1376.64 yuan. After the incident, Zou and his daughter returned the stolen money 1 1376.64 yuan, and were fined 22,753.28 yuan by Zhuji Municipal Bureau of Human Resources and Social Security. The mother and daughter were sentenced on suspicion of fraud. Is there a similar case in Xi 'an? Li Shurong, director of the Medical Insurance Department of Xi 'an Municipal People's Social Security Bureau, said that at present, Xi 'an cannot realize real-time reimbursement of chronic diseases, but it is reimbursed once a year. The insured with chronic diseases needs to pay in advance when purchasing drugs and seeing a doctor after being confirmed by the medical insurance agency. Before the end of the year, carry relevant bills for review and reimbursement. The audit of chronic diseases is strict. At present, Xi 'an has not found any insurance fraud. Cheating more than 3000 yuan may be sentenced. Li Shurong said that medical insurance consists of two parts, one is the money in the personal medical insurance card account, and the other is the money paid by the unit to the medical insurance pooling fund, that is, the pooling fund. Individual accounts can buy their own medicines, but the money in the overall fund belongs to each medical insurance applicant. Its purpose is to share the disease risk and solve the medical expenses of the insured through the mutual assistance of social groups in a certain area. It is the life-saving money of each insured person, and the expenses for hospitalization reimbursement are paid by the overall fund. Zou Mou reimbursed 1 10,000 yuan as her husband, which belongs to insurance fraud. According to the provisions of the Social Security Law, those who defraud 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 a fine of not less than two times but not more than five times the amount defrauded shall be imposed. If a crime is constituted, criminal responsibility shall be investigated according to law. So, how much will be awarded for fraudulent insurance? Article 266 of the Criminal Law explains that defrauding pension, medical care, work injury, unemployment, maternity and other social insurance benefits or other social insurance benefits by fraud, forgery of certification materials or other means is an act of defrauding public and private property. Whoever defrauds public or private property in a relatively large amount (from 3,000 yuan to 10,000 yuan) shall be sentenced to fixed-term imprisonment of not more than three years, criminal detention or public surveillance, and shall also, or shall only, be fined; If the amount is huge (not less than 30,000 but not more than 100,000) or there are other serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than three years but not more than 10 years and shall also be fined; If the amount is especially huge (more than 500,000 yuan) or there are other especially serious circumstances, he shall be sentenced to fixed-term imprisonment of not less than 10 years or life imprisonment, and shall also be fined or confiscated. For the personal account of the medical insurance card, Li Shurong said that the family's medical insurance card can be swiped under the following circumstances-the expenses that should be paid by the individual in the outpatient medical expenses and hospitalization medical expenses incurred by the insured and their families in designated medical institutions (including the scope of self-funded medical expenses outside the basic medical insurance coverage and the scope of medical service facilities), as well as the expenses that should be borne by the individual for special inspections and special treatments during outpatient or hospitalization; The expenses for purchasing drugs in designated retail pharmacies (including the drugs of Chinese medicine with quasi-brand name outside the basic medical insurance drug list and the Chinese herbal pieces and medicinal materials without single or compound payment in the basic medical insurance drug list), the expenses for purchasing health foods of brands such as Guoshijian and Weishijian, and disinfection products (such as gynecological lotion) of brands such as Weixiaojin and Weixiaozhun. ) and the cost of vaccines (such as hepatitis B vaccine, rabies vaccine, tuberculosis vaccine, influenza vaccine, etc.) purchased and injected by the insured and their families in designated medical institutions. , except for free according to regulations); Medical expenses incurred in physical examination, artificial prosthesis installation and non-functional correction in designated medical institutions. However, it is worth noting that if you use your family's medical insurance card to handle hospitalization reimbursement, it is insurance fraud and will be sanctioned by law. If you find someone cheating insurance, you can call 12333 to report it. In addition, if you lose your medical insurance card, you should also call 123 33 to report the loss in time. If you don't know anything, you can consult a lawyer online.
Legal objectivity:
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 particularly 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.