In the field of medical security,fraud,violations and crimes occur frequently,which can be divided into two types ac-cording to their subjects:fraud of insured persons and fraud of designated medical institutions.The current legal system has three levels of regulation system,namely agreement management,administrative supervision and criminal sanctions,and requires effective regula-tion of the latter type of insurance fraud in the context of medical anti-corruption.However,the current criminal law regulation system lacks the corresponding legal basis,and the administrative supervision system also has the ambiguity of the application of law articles,which leads to the difficulty in the execution,so it is necessary for the administrative organs to regulate in advance when the passive law enforcement fails.The introduction of the subject relationship structure theory of unit crime and the responsibility theory of unit in the corporate compliance theory is helpful to clarify the responsibility distribution relationship of medical institutions and their organiza-tional members,promote the accurate application of penalties for corresponding illegal acts in the Regulations on the Use of Medical Se-curity Fund,and also helpful to explore the perfect path for the special compliance of medical insurance funds in designated medical in-stitutions.
关键词
医保基金监管/企业合规/单位犯罪/行政监管/诈骗罪
Key words
medical insurance fund supervision/corporate compliance/unit crime/administrative supervision/fraud
维普
万方数据