| 摘要: |
| “两高一部”发布的《关于办理医保骗保刑事案件若干问题的指导意见》明确规定，定点医药机构骗取医保基金支出的行为，对组织、策划、实施人员按诈骗罪定罪处刑。然而，司法解释不追究定点医药机构的单位刑事责任，不是基于刑法和司法裁判规则，而是源于人社部行政文件和国家医保局将医保服务协议纳入行政协议管理的请示。梳理近四十年来的刑法、修改草案、法律解释、保险法律法规，有助于重新厘清追究定点医药机构单位刑事责任的法律依据。按诈骗罪对单位责任人定罪处刑，这是因为1979年颁布的《刑法》没有规定单位犯罪和合同诈骗罪。然而，全国人大及其常委会从1986年开始就陆续制定法律和单行刑法要求对法人或单位治罪判罚金，1997年修订后的《刑法》明确规定了合同诈骗罪和单位犯罪条款。司法机关应遵循罪刑法定原则，尊重《刑法》第266条“本法另有规定的，依照规定”所表明的诈骗罪与合同诈骗罪的竞合关系，重视以合同诈骗罪判罚单位的案例。司法解释应坚持以刑法为基础指引司法，只有对单位定罪处刑才能真正预防和减少猖獗的医保诈骗行为。 |
| 关键词: 医保诈骗 定点医药机构 单位犯罪 合同诈骗罪 社会保险法 |
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| 基金项目:四川省哲学社会科学重点研究基地、西南财经大学中国金融法治研究中心资助课题“医保诈骗单位犯罪的刑事责任研究”（项目资助号： 25CFL12） |
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| The Unit Criminal Responsibility of Medical and Pharmaceutical Contractors in Healthcare Fraud |
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Xiong Moulin
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| Abstract: |
| The Supreme People's Court, the Supreme People's Procuratorate and the Ministry of Public Security jointly issued the Guiding Opinions on Issues Concerning the Handling of Healthcare Fraud Criminal Cases, stipulating that healthcare fraud committed by the medical and pharmaceutical contractors should only convict Fraud Crime and punish the principals who play a role of organization, planning, or implementation. The immune of unit criminal responsibility by judicial interpretations, nevertheless, was not based on criminal law and case judications but in line with the administrative files of the Ministry of Human Resources and Social Security and National Healthcare Security Administration. A review of the criminal law, amendment drafts, legal interpretations, and insurance rules in the past 40 years is helpful to clarify the rules of conviction and punishment for medical and pharmaceutical entities in healthcare fraud. The article reveals that punishing the principals in according with the Fraud Crime is only based on the absence of unit crime and Contract Fraud Crime in the Criminal Law promulgated in 1979. Nevertheless, the National People's Congress and Standing Committee legislated laws and criminal decisions to seek convictions and fine for corporate and unit alongside 1986, and the Criminal Law amended in 1997 incorporated Contract Fraud Crime and unit crime formally. Judicial organs should abide by the legal principles, concern the overlap between the Contract Fraud Crime and Fraud Crime indicated by Article 266 “where otherwise provided by this law, the relevant provisions shall apply”, and pay attention to the adjudication practices to seek unit criminal responsibility via Contract Fraud Crime. Judicial interpretation needs to keep adherence with the criminal law as judicial guidance, because the rampant healthcare frauds could be prevented and reduced only when the real unit offenders were punished. |
| Key words: Healthcare Fraud, Medical and Pharmaceutical Contractors, Unit Crime, Contract Fraud Crime, Social Insurance Law |
