论医疗欺诈行为

医疗欺诈行为作为提供医疗服务活动中的欺诈行为，具有发生前提、实施主体、行为方式和主观心理等构成要件．从实践中看可归纳三种基本类型即欺诈医疗行为、欺诈宣传行为和欺诈收费行为，医疗欺诈行为根据其不同的具体情形应承担相应的行政、民事和刑事责任。     

欺诈骗取医保基金风险防范的国际比较

采取文献分析法梳理国内外欺诈骗取医保基金风险防范的发展及现况,总结和比较打击欺诈骗保对策,以期为我国提供有价值的参考和建议.欺诈骗保行为的表现形式及成因多样,我国可借鉴国际经验,首要是完善相关法律并成立专门机构,利用大数据技术等手段,加强对医疗服务提供方和需求方的监管.     

医疗欺诈监管对策研究(上)——兼评医疗欺诈犯罪典型案例

2018年以来,医疗欺诈犯罪案件在多地发生,被曝光的案例不乏涉及诈骗、敲诈勒索、故意伤害、强迫交易等.通过梳理多地的医疗欺诈犯罪典型案件,结合笔者处置医疗欺诈投诉的经验教训和对涉案人员的调查,分析医疗欺诈的典型表现与成因,探讨监管、投诉处置、司法鉴定、两法衔接实务中的若干问题,并提出对策.     

法国消费欺诈行为的法律规制及借鉴

法国《消费法典》未规定消费欺诈,而是采用了“商业欺诈行为”的概念,包括作为的商业欺诈行为与疏忽的商业欺诈行为,前者有混淆风险、欺诈陈述、不指明行为实施者三类假定,后者涉及违反实质信息提供义务.商业欺诈行为的主要处罚包括罚款、罚金与监禁,附加处罚包括公告判决、发布更正通告、停止违法行为,缔约方可主张合同无效和损害赔偿,严重情形构成诈骗罪.建议我国系统地设定消费欺诈行为规则,明确不作为构成消费欺诈的条件,强制责任主体自行公告消费欺诈行为等.     

受欺诈行政行为刍议

受欺诈行政行为是指行政主体受行政相对人欺诈陷入错误后作出的具体行政行为。根据其是否直接影响第三人的利益,可以分为有第三人的受欺诈行政行为和无第三人的受欺诈行政行为;根据行政主体工作人员的过失程度,可以分为一般过失的受欺诈行政行为和重大过失的受欺诈行政行为。受欺诈行政行为是无效行政行为。     

诉讼欺诈行为分析及立法构想

诉讼欺诈是一种独特的危害社会的行为,目前我国刑法理论和司法实务界对诉讼欺诈行为的定性还未形成统一意见,而现行刑事立法中对诉讼欺诈行为的处理方式已明显不能满足实践中发生的各种诉讼欺诈案件。因此,本文试通过对诉讼欺诈行为的定性分析,厘清诉讼欺诈行为与诈骗行为的异同,并从立法角度提出设立“诉讼欺诈罪”的建议,从根本上解决对诉讼欺诈案件的处理。     

诉讼欺诈行为概念辨析

诉讼欺诈行为是行为人主动提起诉讼或干预诉讼蓄意破坏司法公正,扰乱司法秩序的行为。目前我国的刑事法学界对诉讼欺诈行为性质的认定存在较大争议。笔者认为,若要客观全面地分析诉讼欺诈行为的性质,首先要界定诉讼欺诈行为的概念。本文在综合分析我国理论界对诉讼欺诈行为概念的不同认识的基础上,从诉讼欺诈行为的基本构成要素出发,对诉讼欺诈行为概念作出全新的界定和认知。     

网络食品宣传欺诈如何治理

国家食品药品监督管理总局近期公布《食品安全欺诈行为查处办法》(征求意见稿),公开向公众征求意见. 食品宣传欺诈,一直备受诟病,尤其是随着互联网的发展,“微商”的加入,更让网络食品交易欺诈问题愈发突出. 宣传欺诈致不公平竞争 征求意见稿将食品安全欺诈行为分为:产品欺诈、食品生产经营行为欺诈、标签说明书欺诈、食品宣传欺诈、信息欺诈、食品检验认证欺诈、许可申请欺诈、备案信息欺诈、报告信息欺诈、提交虚假监管信息等.     

探析合同诈骗罪与合同欺诈行为的区别

在司法实践中如何正确区分合同诈骗罪与合同欺诈行为的界限并非易事。如果不能正确区分这两种行为,就会带来如下恶果:要么将合同诈骗罪定性为合同欺诈行为,从而放纵了犯罪;要么将合同中的合同欺诈行为定性为合同诈骗罪,错误地追究当事人的刑事责任。所以正确界定合同诈骗罪与合同欺诈行为,不仅有重大的实践意义,也有重大的理论意义。文章主要从合同诈骗罪与合同欺诈行为的概念、特征、联系、区别等方面,对合同诈骗罪和合同欺诈行为进行比较系统的研究和探讨,以便更好地指导司法实践。     

我国的破产撤销制度

旧破产法对破产宣告前特定期间内债务人的行为实行绝对无效制度,存在很大弊端。新破产法将债务人的行为分为实际欺诈行为、推定欺诈行为和优惠行为三类。实际欺诈是债务人故意实施的减少责任财产的行为,维持适用无效制度。对于在危机期间内减少责任财产的推定欺诈行为、对个别债权人进行清偿或提供财产担保的优惠行为则可以由破产管理人撤销。     

How the detection of insurance fraud succeeds and fails

Abstract

Insurance fraud is a serious and growing problem, and there is widespread recognition that traditional approaches to tackling fraud are inadequate. Studies of insurance fraud have typically focused upon identifying characteristics of fraudulent claims and claimants, and this focus is apparent in the current wave of forensic and data-mining technologies for fraud detection. An alternative approach is to understand and then optimize existing practices in the detection of fraud. We report an ethnographic study that explored the nature of motor insurance fraud-detection practices in two leading insurance companies. The results of the study suggest that an occupational focus on the practices of fraud detection can complement and enhance forensic and data-mining approaches to the detection of potentially fraudulent claims.     

DIFFUSION OF FRAUD: INTERMEDIATE ECONOMIC CRIME AND INVESTOR DYNAMICS*

Criminologists have studied the spread of fraudulent practices and techniques among perpetrators. This article attempts to contribute to the field by looking at the other side of diffusion, examining the spread of fraud among investors in a case of “intermediate fraud.” Intermediate fraud occurs when fraudulent acts are committed in or by a legitimate business. Using comprehensive archival, interview, and survey data, we analyze a business that exhibited a two‐stage pattern of intermediate fraud: It was created and operated as a legitimate business in the first stage, and then economic crimes were increasingly committed in the second stage. We use diffusion theory to guide our analysis, investigating the ways in which five factors—product attributes, buyer attributes and behavior, seller attributes and behavior, structure of the social network, and method of propagation—influence the adoption and diffusion of investments in oil and gas wells among a population of investors. The case of intermediate fraud is interesting because the factors that contributed to the success of the business in its legitimate stage are the same factors that contributed to the success of the fraud in its illegitimate stage.     

诈骗罪中的财产损害

诈骗罪是事关财产的犯罪,诈骗罪的成立应当要求被害人具有财产损失,即在未遂的情况下,要求欺骗行为具有造成被害人财产损失的危险性;在既遂的情况下,则要求诈骗行为造成被害人现实的财产损失。整体财产减少说、形式性个别财产减少说以及折中说均有不足之处,因此,诈骗罪中的财产损害应当以实质性个别财产减少为基准进行判断,即综合处分行为前后财产的价值,在此基础上,以处分后的财产是否受到损失为基准进行判断。另外,相应给付,欺诈性乞讨、募捐,欺诈性权利行使均可以成立诈骗罪。     

Patient confidentiality statutes in Medicare & Medicaid fraud investigations

The Medicare and Medicaid programs have been burdened with health care providers' fraudulent and abusive practices since their implementation in 1965. To help states discover and prevent Medicare and Medicaid fraud, Congress has enacted statutes permitting access to patients' medical records in investigations of fraud. The majority of states have enacted physician-patient and psychotherapist-patient privilege statutes to protect confidential information from disclosure. Thus, the state's need for patient information conflicts with the patient's right of privacy. This Note discusses several court decisions that have wrestled with the tension between these two policies. The courts, after balancing the state interest in eliminating fraud against the patient's privacy interest, have often allowed disclosure of patient medical records. Although some courts have attempted to limit the extent of the information disclosed, few have set forth explicit standards to protect patient records from unwarranted disclosure of confidential information. This Note suggests guidelines for courts, legislatures and health care providers to uniformly limit the extent of this disclosure.     

The false claims act and the eroding scienter in healthcare fraud litigation

This article addresses the federal government's expansive methods in tackling healthcare fraud, particularly in misapplying the False Claims Act. Although tasked with the obligation to curtail the fraudulent submission of Medicare & Medicaid claims, the U.S. government must rein in the current trend to utilize the False Claims Act against smaller medical providers. As the Act's original focus has ebbed in significance, the government has increasingly applied the False Claims Act to circumstances that do not evince actual fraud. In doing so, federal courts have effectively eroded the statute's critical scienter requirement. The federal common-law doctrines of "payment by mistake" and "unjust enrichment" adequately address the payment of non-fraudulent, albeit false, Medicare & Medicaid claims. Yet the federal government pursues these appropriate remedies only rarely and in the alternative, essentially when the government fails under the False Claims Act. Thus, this article argues for reform, calling for a clearer delineation between remedial and punitive measures. In cases involving smaller medical providers, courts should strictly limit the False Claims Act to those instances where fraud is clearly manifest.     

欺诈的界分

就欺诈的研究视角,大多限于合同欺诈的角度,着眼于欺诈的构成及其法律后果,或者民事欺诈与合同诈骗罪的界分。但此种进路忽略了欺诈行为本身以及侵权法上的欺诈,忽视了侵权法在对欺诈的调整中应有的作用,甚至将侵权法对欺诈行为的控制化为乌有。若从法律行为的效力控制、合同责任、侵权责任承担以及合同诈骗罪的判处等不同的法律调控方式及其作用空间角度考察,可以更加明确对不同层面的欺诈的法律调控,也可更有效保护表意人的合法权益。     

关于对消减负债做假的司法会计鉴定

本文揭露了有的国家机关、企事业单位会计做假账、中介机构假评估的犯罪行为,剖析了弄虑作假的手法,提出了防范的措施。     

Insurance Fraud and the Role of the Civil Law

Two UK Supreme Court decisions have considered insurance fraud. The first, Versloot Dredging BV v HDI‐Gerling Industries Versicherung (The DC Merwestone), concerned the use of a fraudulent device being harnessed to support a legitimate claim which, in the view of the majority, was an area of insurance law in need of re‐evaluation. The second, Haywood v Zurich Insurance Co, concerned the use of fraud to increase the settlement paid by the insurer and whether an insurer, which suspects fraud but has nevertheless chosen to settle a claim, is entitled to set aside the settlement under the tort of deceit where it subsequently discovers proof that it was in fact fraudulent. This case note examines not only the legal implications of the decisions and their likely impact on industry practice, it also focuses on the broader issue of the proper province of the civil law and whether general deterrence can be justified as a proper objective where the criminal law is deficient in punishing fraud because of its higher standard of proof.     

The Economic Consequences of Accounting Fraud in Product Markets: Theory and a Case from the U.S. Telecommunications Industry (WorldCom)

This article studies the effects of accounting fraud on theproduct market. The model presented in this article relies onthe idea that a firm’s financial statements and actionsmust be consistent with each other. If the firm is behavingfraudulently, insofar as its financial statements portray itas relatively efficient, the firm must act accordingly, thatis, increase its market share and/or reduce its prices. If thefirm does not behave in keeping with its fraudulent financials,the market would be able to identify the fraud. As such, themanager will take actions and make pricing decisions that arenot optimal. These actions can have a significant adverse effecton social welfare. This article utilizes the WorldCom case toillustrate the implications of such fraudulent behavior andits economic significance in product markets.