刑事领域医保基金追索法理及实务探讨  

Discussion on the Legal Principle and Practice of Medical Insurance Fund Recourse in the Criminal Field

作　　者：曹德宏 武朝霞 冯如雁 

机构地区：[1]山西省晋中市榆次区医疗保障局,晋中030600

出　　处：《中国医疗保险》2023年第11期73-77,共5页China Health Insurance

摘　　要：医保基金监管力度加强需要纵向持续深入,同时横向监管领域仍有较大拓展空间,有必要予以关注。本文通过对一起大额销售假药审判案例进行分析,对医保基金监管追索范围延伸到刑事领域作法理和实务方面的初步探讨,建议医保部门发挥主观能动性,积极追回被违法使用的基金。同时,建议在制售假药、涉医保基金诈骗等刑事案件中,将保护医保基金、退赔基金损失作为法定步骤予以固定;在医疗事故、医疗损害纠纷、交通肇事、人身伤害等民事案件中,明确医保部门等同民事当事人权利。It is necessary to strengthen the supervision of healthcare security fund vertically,and at the same time,it is necessary to pay attention to the expansion of supervision horizontally.With the analysis of the case of a large-sum sale of counterfeit drugs,this article discusses the legal principle and practice of extending the scope of medical insurance fund supervision to the criminal field.It is suggested that the healthcare security departments should take the initiative and actively recover the illegally used funds.Meanwhile,it is suggested that in criminal cases such as the production and sale of counterfeit drugs and frauds involving medical insurance funds,the protection of healthcare security funds and compensation of fund losses should be fixed as legal steps.In civil cases such as medical accidents,medical injury disputes,traffic accidents,and personal injuries,the healthcare security department has the same rights as civil parties should be confirmed.

关 键 词：假药 违法所得 医保基金追索 

分 类 号：F840.684[经济管理—保险] C913.7[社会学]