摘要
我国刑事立法未对骗取医疗保险基金的行为作出规定,致此类行为的性质认定与司法适用领域乱象丛生;而《刑法》第二百六十六条立法解释的应急性特点明显,只能视为缓解司法压力的权宜之计。对司法实务中骗取医保行为作类型化梳理,可区分为单一主体骗保与复合主体骗保。其性质认定方面,以行为相对方能否陷入错误认识为基础,可将由单一主体实施的骗保行为分别认定为诈骗罪或盗窃罪;医保经办机构工作人员属于国家工作人员,其实施骗保行为应认定为贪污罪;对复合主体骗保则应以身份为中心、以行为为脉络作综合考量。其司法适用方面,犯罪数额的认定应围绕药品、医用耗材的价值转换和犯罪数额认定范围两方面展开;应将数额理解为既遂条件,诈骗或盗窃所得数额未达到“数额较大”标准时同样构成未遂。
The criminal legislation in China does not stipulate the behavior of defrauding the medical insurance fund,which leads to the confusion in the field of nature identification and judicial application.However,the legisla⁃tive interpretation of article 266 of Criminal Law has obvious emergency characteristics,which can only be regarded as a expedient measure to ease the judicial pressure.The behavior of defrauding medical insurance in judicial prac⁃tice can be divided into single subject fraud and complex subject fraud.In terms of its nature identification,based on whether the other side of the behavior can fall into the wrong understanding,the insurance fraud carried out by a single subject can be identified as fraud or theft.The staff of the medical insurance agency belongs to the state staff,and its behavior of insurance fraud should be identified as the crime of corruption.The complex subject insurance fraud should take the identity as the center and the behavior as the context for comprehensive consideration.In terms of judicial application,the determination of crime amount should focus on the value conversion of drugs and medical consumables and the scope of the determination of crime amount.The amount should be understood as a completed condition,the amount of fraud or theft does not meet the"large amount"standard also constitutes an attempt.
出处
《医学与法学》
2023年第4期9-20,共12页
Medicine and Jurisprudence
关键词
医保骗保
医保基金
医疗保险
数额认定
medical insurance fraud
medical insurance fund
medical insurance
amount determination
