Core Viewpoint - The article highlights the increasing challenges in the regulation of medical insurance funds in China, particularly focusing on the rise of fraudulent activities that threaten the integrity of these funds. The judicial system is actively addressing these issues through stringent legal actions against offenders [5][6][7]. Group 1: Medical Insurance Fraud Cases - In 2024, a total of 1,156 medical insurance fraud cases were concluded in first-instance trials, resulting in 2,299 individuals being sentenced, with a year-on-year increase of 131.2% in case closures, recovering over 402 million yuan in losses [5]. - A specific case involved a hospital in Shanxi where fraudulent activities led to the inflation of medical expenses by over 9.7 million yuan, with 7 million yuan successfully defrauded from the insurance fund [6][7]. - Another case highlighted involved a medical institution where the operator was sentenced to 12 years in prison for defrauding over 3.9 million yuan through false medical records and inflated treatment costs [7]. Group 2: Black Market for Recycled Drugs - The article discusses the illegal trade of drugs purchased through fraudulent medical insurance claims, with individuals forming criminal networks to profit from this activity. One individual was sentenced to six years in prison for selling over 390,000 yuan worth of such drugs [8][9]. - The illegal sale of these drugs not only results in financial losses for the medical insurance fund but also poses health risks due to improper storage and potential contamination of the drugs [9]. Group 3: Responsibilities of Insured Individuals - Insured individuals are warned against illegally selling drugs obtained through medical insurance claims, with one case resulting in a sentence of over three years for the offender who sold drugs worth over 220,000 yuan [10][11]. - The article emphasizes that individuals engaging in such fraudulent activities face severe legal consequences, including fines and imprisonment, as the judicial system intensifies its crackdown on medical insurance fraud [11][12]. Group 4: Characteristics of Medical Insurance Fraud - The article outlines four main characteristics of medical insurance fraud: concentration of crime types (mainly fraud), diverse criminal actors (including insured individuals), varied methods of fraud, and significant financial impact on the insurance fund [12]. - The judicial system is committed to strict enforcement against these crimes, aiming to recover losses and protect the integrity of the medical insurance system [13].

Core Viewpoint - The article emphasizes the severe nature of medical insurance fraud, which constitutes a significant infringement on public resources and undermines the rational use of medical resources and the legitimate rights of patients [1][2]. Group 1: Medical Insurance Fund Security - The medical insurance fund is crucial for public health and its safety directly impacts the interests of insured individuals and the sustainable development of the medical insurance system [2][4]. - During the "14th Five-Year Plan" period, the national basic medical insurance coverage rate remains stable at around 95%, with nearly 20 billion instances of medical insurance reimbursements expected from 2021 to 2024, marking a 1.6 times increase compared to 2020 [2][3]. - In 2024, the basic medical insurance fund expenditure is projected to reach 2.98 trillion yuan, with a 5% decrease in personal patient burdens year-on-year [2][3]. Group 2: Characteristics of Fraudulent Behavior - Medical insurance fraud is characterized by a wide range of perpetrators, covert methods, and organized features, leading to significant erosion of limited medical insurance funds [2][5]. - The fraudulent behaviors include systematic fraud by medical institutions, fraud by insured individuals, and the illegal sale of medical insurance drugs [3][4]. Group 3: Legal Actions and Case Studies - The Supreme People's Court has published typical cases to demonstrate its commitment to combating medical insurance fraud and protecting the safety of medical insurance funds [1][3]. - A specific case from a private hospital in Shanxi highlights the severity of systematic fraud, where the hospital inflated drug prices and fabricated hospitalization costs, resulting in over 9.7 million yuan in fraudulent claims [4]. - Recent cases show that individuals involved in the illegal acquisition and sale of drugs purchased through fraudulent medical insurance schemes face severe legal consequences, with one individual sentenced to six years in prison for concealing and disguising criminal proceeds [5].

央视网消息：据最高人民法院网站消息，医保基金是人民群众的"看病钱"、"救命钱"，事关广大群众的 切身利益，事关医疗保障制度健康持续发展，事关国家长治久安。党的十八大以来，以习近平同志为核 心的党中央高度重视医保基金安全，习近平总书记多次就加强医保基金监管作出重要指示批示，党的二 十届三中全会对加强医保基金监管提出明确要求。2024年，最高人民法院坚决贯彻落实习近平总书记重 要指示批示精神和中央部署要求，充分发挥刑事审判职能作用，依法严惩医保骗保犯罪，切实维护医保 基金安全和人民群众医疗保障合法权益。一是制定指导意见。牵头起草《最高人民法院、最高人民检察 院、公安部关于办理医保骗保刑事案件若干问题的指导意见》，明确医保骗保犯罪定罪处罚、法律适 用、政策把握、办案要求及有关工作制度机制等。二是开展专项整治工作。会同国家医疗保障局等有关 部门开展2024年医保基金违法违规问题专项整治，同步部署全国法院开展2024年医保基金违法违规问题 专项整治工作。三是依法严惩医保骗保犯罪。各级人民法院依法从严惩处医保骗保犯罪，重点打击幕后 组织者、职业骗保人等。2024年，全国法院一审审结医保骗保犯罪案件1156件2299人，一 ...

Core Insights - The National Healthcare Security Administration announced that by the end of 2024, the cumulative balance of the medical insurance fund will reach 3.86 trillion yuan [1] - A comprehensive regulatory system for the fund has been established, which includes proactive education, real-time reminders, post-event supervision, and regular inspections [1] - A total of 104.5 billion yuan has been recovered from the medical insurance fund through these regulatory measures [1]