Analysis Of The Governance Path Of Basic Medical Insurance Fraud In My Countr

This paper collects more than 300 cases of health insurance fraud,and using "administrative illegal behavior" and "criminal illegal behavior" as the basis for classification.This paper explores the internal logic of different types of health insurance fraud,and finds that there are three types of conversion pathways from "administrative illegal behavior" to "criminal illegal behavior" in medical insurance fraud cases: “liability for breach of contract”,“administrative responsibility”and“criminal liability”.It is clear that the different types of health insurance fraud should not be treated in isolation,but they are inter-conversion among all types.In other words,There may be multiple legal liabilities in a health insurance fraud.The application of reasonable penalty mechanism is of great significance to the development of health insurance anti-fraud work.Based on the theory of “law enforcement pyramid”,this paper introduces the social cost and social deterrence as variables to obtain the "modified enforcement pyramid" theory.The "modified enforcement pyramid" theory concludes that the default mechanism is the first to be activated in health insurance fraud cases.To a certain extent,which kind of punishment the regulatory authorities eventually adopt depends on the purpose of law enforcement.In addition,this paper argues that the breach penalty should not be considered as fines,and it is in a position to applied at the same time as fines.Considering the convenience of collection,which can directly increase the scale of the health insurance fund,the breach penalty should be applied in preference to fines.For the same fraudulent subject,fines and penalties cannot be applied at the same time.If the administrative organ has received a fine,the judicial organ shall deduct it when determining the plenty.If the judicial organ has found a plenty,the administrative organ shall not receive any fines.