China’s Supreme People’s Court, along with the Supreme People’s Procuratorate and the Ministry of Public Security, has issued new “Guiding Opinions Concerning Handling of Criminal Cases Related to Medical Insurance Fraud.” This initiative aims to strengthen the legal framework against fraudulent activities in the medical insurance sector.
Under the new guidelines, designated medical institutions and drug trading units that illegally obtain medical security fund expenses will face severe penalties. Key personnel involved in the organization, planning, or execution of such fraud will be convicted for the crime of fraud, while national staff members who defraud medical security funds will be charged with corruption. The guidelines outline various illegal practices, including impersonation for medical treatment, falsification of medical documents, fictitious medical services, and improper billing practices.
Local prosecutors will prioritize high-risk activities, focusing on areas such as key diagnoses, false treatments, and the resale of medical insurance drugs. In 2023 alone, prosecutors investigated 1,054 fraud cases, resulting in 1,619 arrests and 3,988 individuals facing lawsuits. The authorities are leveraging digital supervision models to enhance the detection and prosecution of medical insurance fraud, which has seen a significant year-on-year increase. From 2021 to 2023, courts concluded 1,213 cases of medical insurance fraud, with a notable rise in the number of cases and an increasing complexity of criminal methods employed.- Flcube.com
