Insurance fraud is a type of insurance fraud that is common in cases such as health care fraud and insurance fraud.

Both parties to an insurance policy may constitute insurance fraud. Where the insured party of the insurance relationship does not comply with the principle of good faith, intentionally concealing the true situation regarding the subject matter of the insurance, to induce the insurer to underwrite, or use the content of the insurance contract, intentionally creating or fabricating insurance accidents caused by the insurance company damage, in order to seek insurance payouts, are the insured party fraud.

Where the insurer lacks the necessary solvency or unauthorized operation of the business, and the use of the opportunity to formulate insurance terms and premiums, or exaggerated insurance liability to induce, deceive the policyholder and the insured, are the insurer fraud. Insurance fraud, once implemented, is bound to cause harmful results, it is necessary to strictly prevent.

Expanded Information

Disposition of Insurance Fraud:

On December 15, 2018, the National Bureau of Medical Security issued the Interim Measures for Reporting and Rewarding Fraudulent and Fraudulent Acts on the Medical Security Fund. The measures clarify fraudulent and fraudulent insurance behavior involving designated medical institutions and their staff, designated retail pharmacies and their staff, insured persons, and staff of medical security agencies. The coordinated regional medical security departments may reward eligible whistleblowers with a certain percentage of the amount of fraudulent insurance fraud that is substantiated, up to a maximum of 100,000 yuan, which will be paid in principle in a non-cash manner.

In 2019, with the support of big data technology, the Nanjing Municipal Public Security Bureau carried out an industry "sweep" of auto insurance fraud. The "sweep", Nanjing public security once destroyed 109 insurance fraud gangs, found nearly 4,000 cases of insurance fraud, arrested the gang's primary elements and related personnel 356 people.

In 2019, Yunnan Province continued to carry out in-depth combating fraudulent insurance. As of November 26, 2019, the province*** inspected 17,857 designated medical institutions, dealt with 3,984 designated medical institutions, suspended 299 medical insurance services, terminated the service agreement, closed the payment system of 63, imposed administrative penalties on 34, recovered 190 million yuan of medical insurance funds, including 140 million yuan of the principal of the medical insurance fund, and exposed 120 typical cases, which is an effective deterrent to fraudulent and fraudulent insurance The behavior of fraud and fraudulent insurance to form an effective deterrent.

Baidu Encyclopedia - Insurance Fraud

Baidu Encyclopedia - Insurance Fraud