Where can I report someone who has defrauded medical insurance?

The whistleblower can directly report to the medical security department where the fraud occurred or the place where the institution (person) is located, or to the medical security department at a higher level. In accordance with the principle of supervision of the place of medical treatment, the medical security department of the place where the report leads occur is responsible for the medical security department where the institution (personnel) where the report leads occur.

You can also try the following departments:

1. Report to the competent department. Generally speaking, it can be reported at the local county-level and district-level health authorities, such as the county health bureau.

2. If corruption is involved, you can report it to the local Commission for Discipline Inspection.

3. If the above two steps are not accepted, you can directly complain to the competent department for administrative inaction.

4、****。

In short, there are corresponding competent departments in various places, and I wish you success in defending your rights!

You can file a complaint directly with the Medical Insurance Center of the local Social Security Bureau.

The scope of use of the medical insurance card is mainly in the following three aspects:

1. For drug purchase: When the insured person buys medicine in the designated pharmacy, he can use the medical insurance card to pay.

2. For reimbursement: If you go to the hospital to see a doctor, whether it is outpatient or inpatient, and reach the minimum payment line of medical insurance and are within the scope of medical insurance reimbursement, you can use the medical insurance card for reimbursement.

3. For medical treatment: When the participants are sick, they can use the medical insurance card and medical insurance handbook to go to the designated hospital** for treatment. The main process is as follows:

Hold a medical insurance handbook and medical insurance card - register with the hospital medical insurance office - review and verify the card - pay the hospitalization deposit - hospitalization - agree and sign with the patient for self-pay items - cash or medical insurance card.

You can report it to the city and county discipline inspection and supervision department.

You can report the booth in the following 3 ways: (1)**, call the National Medical Security Administration to combat fraud and defraud medical insurance**Special Action to report complaints**-89061397) or report complaints in various places**; (2) WeChat, enter the "Combat Insurance Fraud" column under the "Micro Official Website" menu of the National Health Insurance Bureau's WeChat *** to report the scum; (3) Write a letter and mail the report letter and relevant written materials to the National Medical Security Administration or local medical insurance bureaus. Hope it helps.

Summary. Hello, according to your description, there are two main points to report people who cheat on medical insurance, first, the best way is to call the police and let the police take over the handling, and second, you have to put your own experience of being cheated. For example, chat records, communication, and transfer records should be kept by yourself.

I hope the reply will help you a little, and if you still have any questions, you are welcome to continue to ask questions, thank you.

Hello, according to your description, there are two main points to report people who cheat on medical insurance, first, the best way is to call the police and let the police take over the handling, and second, you have to give yourself the experience of being deceived. For example, chat rock old luck records, ** communication, transfer records keep them well. I hope the reply will help you a little, and if you still have any questions in the future, you are welcome to continue to ask questions, thank you.

Hello, according to your description, there are two main points to report people who cheat on medical insurance, first, the best way is to call the police and let the police take over the handling, and second, you have to give yourself the experience of being deceived. For example, chat rock old luck records, ** communication, transfer records keep them well. I hope the reply will help you a little, and if you still have any questions in the future, you are welcome to continue to ask questions, thank you.

Legal analysis: All materials that can be used to prove the facts of the case can be used as evidence, but the evidence must be verified as true before it can be used as the basis for a verdict.

Legal basis: Criminal Procedure Law of the People's Republic of China Article 48 All materials that can be used to prove the facts of a case are evidence. Evidence includes:

1) Physical evidence; (2) documentary evidence; (3) Witness testimony; (4) The victim's statement; (5) Confessions and justifications of criminal suspects or defendants; (6) Reading appraisal opinions; (7) Records of inquests, inspections, identifications, investigative experiments, and so forth; (8) Audio-visual materials and electronic data. Evidence must be verified to be true before it can be used as the basis for a verdict.

The evidence required to report medical insurance fraud includes: forged medical documents or invoices, and forged medical service bills by insured persons. The penalty for medical insurance fraud shall be a fine of not less than two times but not more than five times the amount obtained by fraud, and the social insurance administrative department shall order the return of the medical insurance money obtained by fraud; Where there are unlawful gains, the unlawful gains are to be confiscated and sanctions are to be given in accordance with law.

Medical insurance fraud is as follows:

1.Fabricating medical services, forging medical documents and bills, and defrauding medical insurance**;

2.providing false invoices for insured persons;

3.Crediting the medical expenses that should be borne by the individual into the scope of medical insurance** payment;

4.Handling medical insurance benefits for persons who do not fall within the scope of medical insurance;

5.providing credit card billing services for non-designated medical institutions;

6.Hospitalization under a pseudonym;

7.collusion in the exchange of drugs, consumables, items, diagnosis and treatment items, etc., to defraud medical insurance expenditures;

8.Other acts of fraud and insurance fraud by designated medical institutions and their staff.

Legal basis

Article 88 of the Social Insurance Law of the People's Republic of China.

Where social insurance benefits are obtained by fraud, falsification of supporting materials, or other means, the social insurance administrative department shall order the return of the social insurance money obtained by fraud and impose a fine of not less than two times but not more than five times the amount obtained by fraud.

Article 91 of the Social Insurance Law of the People's Republic of China.

Anyone who violates the provisions of this Law by concealing, transferring, misappropriating or misappropriating social insurance** or investing and operating in violation of regulations, shall be ordered to recover by the social insurance administrative department, financial department or auditing institution; where there is a shout of illegal gains, the illegal gains are to be confiscated; The directly responsible managers and other directly responsible personnel are to be given sanctions in accordance with law.

Article 266 of the Criminal Law of the People's Republic of China.

where public or private property is defrauded, and the amount is relatively large, a sentence of up to three years imprisonment, short-term detention or controlled release is to be given, and/or a fine; where the amount is huge or there are other serious circumstances, a sentence of between three and ten years imprisonment and a concurrent fine is to be given; where the amount is especially huge or there are other especially serious circumstances, a sentence of 10 or more years imprisonment or indefinite imprisonment is to be given, and a concurrent fine or confiscation of property. Where this Law provides otherwise, follow those provisions.

Evidence required to report medical insurance fraud: 1. To report insurance fraud by medical institutions, you need to provide forged medical documents or invoices. 2. To report insurance fraud in retail pharmacies, false invoices need to be provided.

3. To report the insurance fraud of the insured person, it is necessary to provide the forged medical service bill of the insured person.

Article 10 of the Interim Measures for Rewarding Whistleblowers for Reporting Fraudulent Acquisition of Medical Security** shall be rewarded if the following conditions are met at the same time: (1) The report is verified to be true, causing a loss of medical security or avoiding the loss of medical security due to the report; (2) The main facts and evidence provided by the whistleblower are in the possession of the administrative department for medical security; (3) The whistleblower chooses to be willing to receive a reward for reporting.

Legal analysis: All materials that can be used to prove the facts of the case can be used as evidence, but the evidence must be verified as true before it can be used as the basis for the verdict of the case.

Legal basis: Article 48 of the Criminal Procedure Law of the People's Republic of China All materials that can be used to prove the facts of a case are evidence. Evidence includes:

1) Physical evidence; (2) documentary evidence; (3) Witness testimony; (4) The statement of the victim of the Yebu Lun; (5) Confessions and justifications of criminal suspects or defendants; (6) Appraisal opinions; (7) Records of inquests, inspections, identifications, investigative experiments, and so forth; (8) Audio-visual materials and electronic data. Evidence must be verified to be true before it can be used as the basis for a verdict.