The president of the hospital led the prescription to deceive the medical insurance fund for more than 1 million yuan to be sentenced to 4 years in prison

Cover Journalist Tian Zhi Road

Recently, the Sichuan Provincial Procuratorate announced several typical cases of criminal protest. Yang Moumou, the president of a hospital in Shifang City, was entered into the inspection and treatment project by the nurse by hinting that the doctor opened the prescription and the number of hospitalization days. Yang Moumou and the person involved in the case constituted a fraud, and they were sentenced and fined after trial.

Incident: "cooperation" of superiors and subordinates to cheat medical insurance funds for hospital entertainment

A hospital is a non -profit comprehensive hospital. From January 2015 to July 2016, Yang Moumou served as the president of the hospital, presided over comprehensive work, and was in charge of financial work; Li Mou served as the hospital's chief financial officer, in charge of medical insurance work, and assisted in financial work; The hospital cashier, doctor.

When Yang Moumou held the hospital conference, he hinted to the medical staff of the hospital that the medical insurance fund was deceived by doctors to open prescriptions and increase the number of hospitalization days. Subsequently, the hospital entered the examination and treatment project by a doctor's false prescription and the number of hospitalization days, and then the number of drugs was entered into the number of pharmacies to deceive the medical insurance fund.

Li is responsible for the specific deception of the medical insurance fund accounting and reporting. Hao Moumou cooperates with expenditure and uses cheating medical insurance funds. The funds that are cheated are used for the hospitality expenses, travel expenses, and employee salary of a hospital.

After judicial accounting, from January 2015 to June 2016, a hospital deceived more than 1.76 million yuan in medical insurance funds through the above way. As of October 12, 2017, a hospital has returned the above medical insurance funds in full.

The People's Procuratorate of Shifang City charged the accusations that the defendants Yang Moumou, Li Mou, and Hao Moumou committed fraud. On December 19, 2017, the People's Court of Shifang City made a first trial judgment to determine the crime of the unit in this case. Three years; Li Mou's imprisonment for one year and ten months, two years and six months in prison; Hao Moumou was sentenced to one year and eight months, and the suspended sentence was two years.

On January 3, 2018, the People's Procuratorate of Shifang City filed a protest to the Deyang Intermediate People's Court, arguing that the first instance judgment had an error in the case of the contract involved in the case, resulting in the crime error and sentencing of the case.

Prosecution: Contract fraud conviction errors The court to judge the crime of fraud

On March 19, 2018, the People's Procuratorate of Deyang City decided to support protest. The prosecutor appeared in court to make a court opinion on the focus of the protest dispute: the case involved in the contract "Deyang City's Urban Basic Medical Insurance Point Medical Institutional Medical Services Agreement" was an administrative agreement, which did not meet the composition of the crime of contract fraud. Because the signing of the agreement is the administrative subject, the agreement content reflects the management function of the administrative organs on medical insurance funds. The agreement reflects that the relationship between the two parties is the fund approval relationship. Dharma adjustment. The three defendants used the agreement to deceive the medical insurance funds. The crime composition of the crime of contract fraud was not concluded, so the three defendants could not be determined that the three defendants constituted the crime of contract fraud.

According to the "Interpretation of Article 266" of the Standing Committee of the National People's Congress, fraud, falsification of certification materials or other means to deceive social insurance benefits such as medical care, which belongs to Article 266 of the Criminal Law. Behavior. At the same time, in the Ministry of Human Resources and Social Security and the Ministry of Public Security's "Notice on Strengthening the Investigation and Transfer of Social Insurance Fraud Cases" (Ministry of Human Resources and Social Security [2015] No. 14) and other standardized documents, it also clarified the case The crime of fraud is investigated for criminal responsibility in accordance with the law.

The "Interpretation of Article 30" of the Standing Committee of the National People's Congress stipulates that "corporate, enterprises, institutions, agencies, groups and other units implement the behavior stipulated in the criminal law. For those who organize, plan, and implement this hazardous social behavior to investigate criminal responsibility in accordance with the law. "This case shows the characteristics of the unit's implementation of fraud, but the criminal law and other laws have not stipulated the criminal liability of the units to implement fraud. The defendant's criminal liability for fraud complied with the provisions of the above legislation.

On December 7, 2018, the Deyang Intermediate People's Court made a second trial judgment, adopted the prosecutor's protest opinion, revoked the original judgment, identified the three defendants to commit fraud, sentenced the defendant Yang Mou to four years in prison, and fined fifth of RMB five 10,000 yuan; the defendant Li was sentenced to three years in prison and fined 30,000 yuan; the defendant Hao Mou was sentenced to three years in prison, three years in probation, and a fine of 20,000 yuan.

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