论医疗服务协议对骗保行为的规制方法——惩罚性赔偿的法理与制度设计  

On the Regulation of Medical Service Agreement to Fraud Insurance——the Legal Principle and System Design of Punitive Damages

作　　者：娄宇[1] Lou Yu(School of Civil Economics and Law,China University of Political Science and Law,Beijing,100088)

机构地区：[1]中国政法大学民商经济法学院,北京100088

出　　处：《中国医疗保险》2018年第10期17-20,共4页China Health Insurance

基　　金：国家社会科学基金青年项目--"职工基本医疗保险制度的规范化与立法研究";批准号:13CFX107

摘　　要：医疗服务机构骗保是我国基本医疗保险领域的一大顽疾,社会保险经办机构作为第一线的监管者,肩负着繁重的工作任务和压力。按照现有法律和部门规章的要求,经办机构只能通过协议管理来履行监督管理的职能。从经办机构的法律性质和医疗服务协议的法律性质来看,经办机构更适合通过民事法律规制的方法来治理骗保行为;从规制路径的法律制度适用原理来看,可以考虑引入消费者合同中的惩罚性赔偿制度并规定暂停支付和财产保全的民事程序措施,以此实现威慑骗保者和保障参保人群体的双重效果。Medical service agencies defraud insurance is a stubborn disease in the field of basic medical insurance in China. As the front line supervisor, social insurance agencies shoulder heavy tasks and pressures. According to the requirements of existing laws and departmental regulations, agencies can only perform the functions of supervision and management by agreement. Judging from the legal nature of the agency and the legal nature of the medical service agreement, the agency is more suitable to govern the fraudulent insurance behavior by means of the civil legal regulation. Judging from the applicable principle of the legal system of the regulation path, we can consider introducing the punitive compensation system in the consumer contract and stipulating the suspension of payment and property insurance. The entire civil procedure measures can achieve double effects of deterrent fraud and protection of the insured group.

关 键 词：医疗服务协议 协议管理 骗保 惩罚性赔偿 违约金 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]