According to the WeChat official account of the National Health Insurance Administration, the medical insurance fund is the people's "medical money" and "life-saving money", and every penny is related to the well-being of people's livelihood and the sustainable development of the medical insurance system. Since the beginning of this year, the National Healthcare Security Administration, together with the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, the National Health Commission, the State Administration for Market Regulation, the State Administration of Traditional Chinese Medicine, and the State Drug Administration, has carried out a special rectification of prominent issues in the management of healthcare security funds nationwide. Healthcare security departments in various regions have quickly deployed and implemented measures, and together with relevant departments, have investigated and dealt with a number of cases of fraud and insurance fraud. In order to fully utilize the warning, education, and guidance role of the case, and continue to maintain the high-pressure situation of fund supervision, 7 typical cases of personal fraud and insurance fraud have been exposed, sounding the alarm with the case as a reference! Case 1: Li's fraudulent medical treatment and sale of medical insurance drugs in Shenzhen, Guangdong Province. The Shenzhen Medical Insurance Bureau, relying on big data models, detected abnormal drug prescribing behavior among multiple insured persons in the city, including Li. They immediately joined forces with public security organs to conduct in-depth analysis and rigorous investigation. After investigation, in early 2023, Li accidentally saw someone online saying "medical insurance cashing out", and had the idea of using someone else's medical insurance account to resell drugs to make money. He then searched online for netizens willing to provide Shenzhen medical insurance account information and provided them with "medical insurance cashing out" services. During the period from February 2023 to July 2024, Li used the medical insurance account information obtained from netizens to frequently impersonate and go to multiple hospitals and pharmacies in Shenzhen to seek medical treatment and purchase drugs. He then resold the drugs to the owner of a pharmacy, Wang, at a price lower than the market price, in order to obtain cash and return a certain percentage of the money to the netizens who provided the account information. According to statistics, Li has repeatedly impersonated and sold drugs, defrauding a total of 93013.68 yuan from the medical insurance pooling fund; Wang repeatedly purchased "reflux drugs" from Li through illegal channels, and paid a total of 169025.00 yuan for the purchase of drugs. After the incident, Li, Wang, and the insured who provided medical insurance account information were criminally detained by the public security organs in accordance with the law. After the insured gradually returned the stolen money, Li returned the remaining stolen money of 22495.63 yuan and Wang returned the stolen money of 91820.63 yuan. In March 2025, the Nanshan District People's Court in Shenzhen sentenced Li to 2 years and 4 months in prison and a fine of 6000 yuan for fraud, and sentenced Wang to 1 year and 6 months in prison and a fine of 5000 yuan for covering up and concealing criminal offenses. Case 2: A couple of drug traffickers in Beijing engaged in the fraudulent sale of medical insurance drugs. In 2024, the Beijing medical insurance department, in collaboration with the public security organs, launched a special operation to crack down on criminal gangs involved in the sale of "returned drugs" from medical insurance. Through big data screening, abnormal data was discovered and the target was identified as a couple of migrant workers from other places, Yu and Wang. On December 10, 2024, the Chaoyang police in Beijing arrested Yu and Wang at their temporary residence and seized 2932 boxes of 57 types of drugs involved in the case from their rented warehouse. After the two of them arrived at the scene, they confessed to the criminal facts and admitted to joining the drug collection group by chance. They printed a large number of "high priced drug collection" business cards and distributed them to nearby markets and residential areas. They actively asked elderly people passing by if they had any extra medical insurance drugs. In 2024, Yu and Wang purchased drugs from the elderly at a price 0.5-5 yuan lower than the market price, and then resold them to the next family at an additional price of 1-2 yuan. After verification, the amount of drugs involved in the case reached over 110000 yuan. In May 2025, both Yu and Wang were sentenced to one year and two months in prison, suspended for one year and six months, and fined 20000 yuan by the Chaoyang Court in Beijing for concealing and concealing their crimes. Next, the medical insurance department of Beijing will impose administrative sanctions and penalties on insured individuals involved in the resale of drugs in accordance with the law. Case Three: Qiu and Ke, insured persons in Xiaogan City, Hubei Province, used outpatient treatment for chronic diseases to resell medical insurance drugs and defraud insurance. On October 18, 2022, the medical insurance department of Yunmeng County, Xiaogan City, Hubei Province, found that the outpatient reimbursement amount for chronic diseases patients Qiu and Ke at Yunmeng County Traditional Chinese Medicine Hospital was abnormally high during daily inspections. The medical insurance department immediately conducted in-depth analysis and judgment on the abnormal situation, and transferred relevant clues to the public security organs for investigation. After investigation, Qiu and Ke illegally took advantage of their outpatient chronic and special disease medical insurance benefits to falsely prescribe organ transplant anti rejection drugs and resell them, causing significant losses to the medical insurance fund. Among them, the amount involved in Qiu's case reached 181823.75 yuan, the amount involved in Ke's case was 77851.73 yuan, and the amount of their joint crime was 40825.78 yuan. On June 23, 2025, the court sentenced Ke to 2 years in prison and fined him 5000 yuan in accordance with the law; Qiu was sentenced to 3 years and 9 months in prison, fined 20000 yuan, and all illegal gains of the two individuals were recovered in accordance with the law. Case 4: Hu, a insured person in Shanghai, is suspected of reselling medical insurance drugs and defrauding insurance. In February 2025, the medical insurance department found through big data analysis that Hu, a 74 year old retired insured person of Shanghai's employee medical insurance, purchased drugs from an outpatient department in Shanghai on November 12, 2024, and resold them on January 18, 2025 at a pharmacy in another province or city, suspected of reselling "returning drugs" and defrauding insurance. The Shanghai medical insurance department immediately launched a special inspection. After examination and inquiry, Hu acknowledged the fact that Wenxin Granules, Weifuchun Capsules and other drugs were resold, and issued diabetes, Parkinson's disease and other related drugs for others. The Shanghai medical insurance department has dealt with the insured Hu in accordance with the law and regulations, recovering the lost medical insurance fund of 5223.31 yuan and imposing a fine of 13320.00 yuan. At present, the case has been transferred to the public security organs for further investigation. Case 5: Karamay Medical Insurance Bureau of Karamay, Xinjiang Uygur Autonomous Region found that retired insurance participants living in Anhui Province for a long time had doubts about the amount of bills submitted by a certain person when they talked about the issue of false bills to defraud insurance. The medical insurance department quickly held a joint meeting with multiple departments such as public security and justice, and formed a special working group to conduct cross provincial investigations and verifications. After investigation, from December 2011 to January 2022, Tan Moumou fraudulently obtained medical insurance reimbursement for 27 times by purchasing forged and altered medical invoices and expense lists after self paying for medical treatment in Anhui. The amount involved in the case was as high as 426218.45 yuan. In 2024, the court of Baijiantan District, Karamay City sentenced Tan to commit the crime of fraud according to law, sentenced him to three years' imprisonment, four years' probation, fined 50000 yuan, and ordered him to refund the fraud insurance funds in full. Case 6: Gao, a insured person in Baicheng City, Jilin Province, included medical expenses already paid by a third party in the medical insurance duplicate reimbursement fraud case. In April 2025, the medical insurance bureau of Zhenlai County, Baicheng City, Jilin Province, discovered through big data analysis that urban and rural residents' medical insurance insured persons had cheated on insurance. Gao included medical expenses already paid by a third party in the medical insurance duplicate reimbursement case, suspected of defrauding the medical insurance fund. The medical insurance bureau of Zhenlai County immediately launched a special investigation. After investigation and verification, it was found that Gao was hospitalized on July 2, 2022 due to a traffic accident, and the medical expenses had been paid by the party responsible for the accident, which did not meet the conditions for medical insurance reimbursement. But Gao concealed the fact of third-party compensation and went to the Zhenlai County Medical Insurance Handling Center to apply for reimbursement, illegally embezzling 27394.69 yuan from the medical insurance fund. According to Article 30, Paragraph 2 of the Social Insurance Law of the People's Republic of China, the Zhenlai County Medical Insurance Bureau has ordered Gao to return the embezzled medical insurance fund of 27394.69 yuan. At present, the case has been transferred to the public security organs for further investigation. Case Seven: Zhang, a insured person in Tianjin, fraudulently used someone else's medical insurance card to seek medical treatment. In February 2025, the Tianjin medical insurance department, while deepening the execution connection with the public security organs and jointly analyzing clues, discovered that Zhang, a insured person, had engaged in illegal behavior of using someone else's medical insurance card to seek medical treatment. After investigation, Zhang often felt unwell in the past year and took chances to avoid the waiting period for commercial insurance. She used her friend's medical insurance card to carry out outpatient examinations, hospitalizations, surgeries, and other medical activities. Due to the similarity in age and appearance between Zhang and his friend, the medical staff at the medical institution did not notice any clues, thus deceiving the medical insurance fund to pay medical expenses of 11284.99 yuan. According to the "Regulations on the Supervision and Management of the Use of Medical Security Funds", the medical insurance department of Tianjin ordered Zhang to return 11284.99 yuan for the illegal use of medical insurance funds, impose a fine of 22569.98 yuan, and suspend his medical expenses settlement online for 2 months. At present, the case is being further connected with the public security organs. The safety of the medical insurance fund is closely related to the vital interests of every insured person. Fraudulent and fraudulent behavior not only undermines the fairness of the medical security system, but also damages the "life-saving money" of those who truly need help. The National Healthcare Security Administration hereby solemnly reminds all insured persons to abide by medical insurance laws and regulations, and not to cross the legal red line due to momentary greed. Medical insurance departments at all levels will continue to increase regulatory efforts, rely on technical means such as drug traceability codes, deepen multi departmental cooperation, and have zero tolerance for insurance fraud. If you discover any clues of fraud or insurance fraud, you can call the reporting hotline 010-89061396 or 010-89061397 to jointly protect our "life-saving money"! (New Society)