社会医疗保险诈骗犯罪对策探究

Study on Countermeasures of Social Medical Insurance Fraud

社会医疗保险诈骗并非刑法规定的具体罪名,通常按照诈骗罪进行处理,实务中对于自然人实施医保诈骗犯罪按诈骗罪处理并无争议,但以单位为主体实施此类犯罪所需要适用的具体罪名有一定争议。社会医疗保险诈骗犯罪存在着犯罪嫌疑人相对确定、犯罪行为存续时间长、诈骗手段多样化等特点,且存在着对医疗保险监管力度不够、完整医疗信息库缺失等问题,导致社会医疗保险诈骗犯罪案件频发,因此探索完善的监督检查体系、提升多部门联动监督机制和依托大数据的智能监控机制等措施的应用是保障国家医疗保障基金不被损害和流失的必然举措。

Social medical insurance fraud is not a specific crime stipulated in criminal law,and is usually treated as a crime of fraud.There is no dispute that the crime of health insurance fraud committed by natural person should be treated as the crime of fraud,but there is some dispute about the specific charges that should be applied to the crime committed by the unit as the main body.Social medical insurance fraud crime is characterized by relatively certain criminal suspects,long duration of criminal behavior,diversified means of fraud,and there are problems such as incomplete supervision of medical insurance and lack of medical information database,resulting in frequent social medical insurance fraud cases.Therefore,it is necessary to explore the application of measures such as improving the supervision and inspection system,enhancing the multi-department linkage supervision mechanism and relying on big data intelligent monitoring mechanism to ensure that the national medical insurance fund is not damaged and lost.