Selling medical insurance drugs, issuing false receipts, and seeking medical treatment under false names... Typical cases of individuals defrauding medical insurance funds have been exposed and embezzling the "wool" of medical insurance, which harms others, oneself, and will be caught! The medical insurance fund is the "medical money" and "life-saving money" of the people, and every penny is related to the well-being of the people and the sustainable development of the medical insurance system. In order to fully utilize the warning, education, and guidance role of the case, and continue to maintain the high-pressure situation of fund supervision, the National Healthcare Security Administration recently announced 7 typical cases of personal fraud and insurance fraud, involving reselling medical insurance drugs, issuing false receipts, impersonating medical treatment, and repeated reimbursement. This is the first time that the National Healthcare Security Administration, in conjunction with relevant departments, has announced a typical case of individuals defrauding medical insurance funds since launching a special campaign to address prominent issues in medical insurance fund management nationwide. Out of the 7 typical cases of being sentenced for reselling medical insurance drugs, 4 were related to defrauding insurance by reselling medical insurance drugs. According to relevant laws and regulations, individuals who take advantage of the opportunity to enjoy medical insurance benefits to resell drugs, accept cash or physical returns, or obtain other illegal benefits shall be ordered to rectify by the medical security administrative department; Those who cause losses to the medical security fund shall be ordered to return it; For insured individuals, their online settlement of medical expenses will be suspended for 3 to 12 months. If an individual commits the aforementioned acts with the purpose of defrauding medical insurance funds, resulting in losses to the medical insurance funds, they shall also be fined by the medical security administrative department for the amount defrauded, which is between two and five times the amount defrauded. If the perpetrator commits the aforementioned acts with the purpose of illegal possession and fraudulently obtains medical security fund expenditures, in accordance with Article 266 of the Criminal Law, they shall be convicted and punished for the crime of fraud. In the case of insured persons Qiu and Ke in Xiaogan City, Hubei Province, who used their outpatient treatment for chronic and special diseases to sell medical insurance drugs for insurance fraud, Qiu and Ke illegally took advantage of their own outpatient treatment for chronic and special diseases to falsely prescribe organ transplant anti rejection drugs and resell them, resulting in significant losses to the medical insurance fund. Among them, Qiu was involved in a case worth over 180000 yuan, Ke was involved in a case worth over 77000 yuan, and the two committed a joint crime worth over 40000 yuan. The court sentenced Ke to 2 years in prison and imposed a fine of 5000 yuan in accordance with the law; Qiu was sentenced to 3 years and 9 months in prison, fined 20000 yuan, and all illegal gains of the two individuals were recovered in accordance with the law. In the typical case announced this time, big data screening played an important role in cracking down on "returning drugs" through big data screening. In recent years, some people have used methods such as "medical insurance cash withdrawal" and "high price recycling" to induce insured persons to resell medical insurance drugs. This type of drug obtained through medical insurance reimbursement channels and illegally resold in the market is called "return drug". In 2024, the medical insurance department of Beijing, in collaboration with the public security organs, carried out a special operation to crack down on criminal gangs involved in the resale of medical insurance "returning drugs". Through big data screening, abnormal data was discovered and the target was identified as a couple of migrant workers named Yu and Wang from other places who came to Beijing for work. The two purchased drugs from nearby elderly people at a price 0.5 to 5 yuan lower than the market price, and then resold them to their next home at an additional price of 1 to 2 yuan. The amount of drugs involved in the case was as high as more than 110000 yuan. In May of this year, Yu and Wang were sentenced to one year and two months in prison, suspended for one year and six months, and fined 20000 yuan by the Chaoyang District Court of Beijing for concealing and concealing their criminal activities. It is reported that through "scanning codes to purchase drugs", it can effectively combat fraudulent activities such as reselling drugs and better protect the medical insurance wallet. Starting from July this year, all drugs sold by designated medical institutions must scan traceability codes in order to proceed with medical insurance settlement. Traceability codes are like the "electronic ID card" of drugs, which should only have a record of being scanned and sold once. If they appear multiple times, there is a possibility of counterfeit drugs, "returned drugs," or drugs being sold in exchange. In the case of Hu Moumou suspected of reselling medical insurance drugs to defraud insurance, the medical insurance department discovered through big data analysis that the drugs purchased by Hu Moumou, a 74 year old retired insured employee of Shanghai's medical insurance, at a certain outpatient department in Shanghai in November 2024 were resold on January 18 at a pharmacy in another province or city, suspected of reselling "returned drugs" to defraud insurance. After review and inquiry, Hu admitted to reselling drugs and issued diabetes, Parkinson's disease and other related drugs for others. The Shanghai medical insurance department recovered the lost medical insurance fund of 5223.31 yuan and imposed a fine of 13320 yuan on Hu. Zero tolerance for insurance fraud. Medical insurance fraud methods are constantly emerging, and the typical cases announced this time also exposed personal insurance fraud methods such as issuing false receipts, including including medical expenses already paid by third parties in medical insurance duplicate reimbursement, and seeking medical treatment under false names. The medical insurance fund is a universal and limited resource shared by the general public. As beneficiaries of policy dividends, insured individuals also have the obligation to enjoy medical insurance benefits in accordance with the law and truthfully, and maintain the healthy and sustainable development of the medical insurance fund. Don't use the twisted brain of exploiting the "wool" of medical insurance, it will harm others, harm oneself, and you will be caught. The National Healthcare Security Administration solemnly reminds all insured individuals to abide by medical insurance laws and regulations, and not to cross the legal red line due to momentary greed. The relevant person in charge of the National Medical Insurance Administration stated that medical insurance departments at all levels will continue to strengthen supervision, rely on technical means such as drug traceability codes, deepen multi departmental cooperation, and severely crack down on insurance fraud. (New Society)