Calls impersonating the Medical Insurance Bureau to handle secondary reimbursement are a scam; a Shenzhen lawyer analyzes three types of legal liability.
Recently, the Hunan Provincial Healthcare Security Administration issued a statement refuting rumors: some criminals are impersonating staff of the healthcare security department, using pretexts such as "resident medical supplementary coverage has arrived" or "medical insurance secondary reimbursement" to induce insured individuals via phone calls and text messages to click links, download software, or provide personal information. The Hunan Provincial Healthcare Security Administration made it clear that both basic medical insurance and critical illness insurance have already achieved "one-stop" settlement, and there is simply no such thing as "secondary reimbursement." Any request for action under this pretext is false information.
Such scams are not unique to Hunan. As a major city with a large influx of population, Shenzhen has a complex structure of insured individuals, and similar cases of fraudsters impersonating medical insurance or social security departments occur from time to time. From a lawyer's perspective, this is not just a rumor-refuting news item; it also involves multiple criminal law issues such as fraud, infringement of citizens' personal information, and aiding information network criminal activities, as well as the practical challenges of protecting insured individuals' personal information and recovering financial losses.
What crimes may be committed by impersonating the Medical Insurance Bureau to carry out fraud?
From a criminal law perspective, the most directly applicable charge for such conduct is fraud as stipulated in Article 266 of the Criminal Law. The perpetrator fabricates the fact of "secondary reimbursement of medical insurance," causing the insured to fall into a mistaken understanding, and then induces them to click links, provide bank card information, or transfer money directly, which meets the constitutive elements of fraud. According to the Interpretation of the Supreme People's Court and the Supreme People's Procuratorate on Several Issues Concerning the Specific Application of Law in Handling Criminal Cases of Fraud, defrauding public or private property valued at three thousand yuan to ten thousand yuan or more meets the standard of "relatively large amount," and may be punished by fixed-term imprisonment of not more than three years, criminal detention, or control, and concurrently or separately with a fine; if the amount is especially huge or there are other especially serious circumstances, the maximum penalty may be life imprisonment.
If the perpetrator obtains personal information such as the insured person's ID number, bank card number, or medical insurance account during the process, it may also simultaneously constitute the crime of infringing on citizens' personal information as stipulated in Article 253-1 of the Criminal Law. In judicial practice, illegally obtaining, selling, or providing citizens' personal information that reaches a certain quantitative threshold may lead to criminal liability. In multiple telecom fraud-related cases heard by courts in the Shenzhen area in recent years, for those who simultaneously violate the crime of fraud and the crime of infringing on citizens' personal information, they are usually convicted and punished according to the provisions with the heavier penalty, or multiple crimes are punished concurrently.
In addition, providing technical support, bulk SMS channels, fake link setup, or other forms of assistance to fraud groups may constitute the crime of aiding information network criminal activities as stipulated in Article 287-2 of the Criminal Law. In Shenzhen's judicial practice, the number of such "aiding trust" crimes has grown significantly, and many young people have ended up behind bars for selling bank cards, phone cards, or helping build websites for small gains.
Why is "secondary reimbursement" a scam? The legal logic of medical insurance settlement.
Many insured individuals are deceived because they do not understand the medical insurance settlement system. The response from the Hunan Provincial Healthcare Security Administration highlights the key point: basic medical insurance and critical illness insurance have already achieved "one-stop" settlement. This means that when insured individuals seek medical treatment or purchase medicines at designated medical institutions or pharmacies, the system automatically completes the basic medical insurance reimbursement and the secondary payout from critical illness insurance. There is no need for individuals to apply separately, and there is no such thing as "secondary reimbursement."
From a legal perspective, Article 28 of the Social Insurance Law stipulates that medical expenses that conform to the basic medical insurance drug catalog, diagnostic and treatment items, medical service facility standards, as well as emergency and rescue treatment, shall be paid from the basic medical insurance fund in accordance with national regulations. Article 29 clarifies the direct settlement system. Critical illness insurance, on the other hand, provides further protection against high medical expenses on top of basic medical insurance, and its settlement is likewise automatically completed through the medical insurance system.
In other words, in the legitimate medical insurance reimbursement process, insured individuals do not need to click on unfamiliar links to "confirm" any benefit payments, nor do they need to download unofficial apps to carry out operations. Any request to click a link, provide a verification code, or transfer money to a "safe account" violates the basic legal logic of medical insurance settlement and can be judged as a scam.
Shenzhen health insurance participants should pay particular attention: Shenzhen has already implemented "mobile handling" for health insurance services, but the official channels are only a few platforms such as the "Shenzhen Health Insurance" WeChat public account, Yue Sheng Shi, and iShenzhen. Anyone claiming to be a staff member of the Health Insurance Bureau and asking you to operate through other links should be hung up on immediately, and you should call 12333 or 12345 to verify.
After receiving a scam call, how can ordinary people protect their rights and stop their losses?
If you accidentally clicked a link or provided personal information, the first step is to stop the damage immediately. If bank card information has been leaked, you should call the bank right away to report the loss and freeze the account; if a transfer has already occurred, you should immediately call 110 to report it to the police and preserve evidence such as call records, text message screenshots, and transfer receipts. According to Article 110 of the Criminal Procedure Law, any unit or individual that discovers facts of a crime or a criminal suspect has both the right and the obligation to report or tip off the public security organ, the people's procuratorate, or the people's court.
The second step is to verify with the medical insurance department. Both the Hunan Provincial Healthcare Security Administration and the Shenzhen Municipal Healthcare Security Administration have made it clear that medical insurance policy consultations and service handling should be conducted through official channels. Insured individuals can call the 12333 medical insurance service hotline or visit a medical insurance service window to verify their medical insurance status and confirm whether there are any abnormalities.
The third step is to watch for follow-up risks to personal information. Even if there is no direct financial loss, once personal information is leaked, it may be used to register fake accounts, apply for online loans, and so on. It is advisable to check your personal credit report regularly, and if you find anything unusual, promptly raise an objection with the credit reporting agency. According to Article 69 of the Personal Information Protection Law, where the processing of personal information infringes on personal information rights and interests and causes harm, and the personal information processor cannot prove that it is not at fault, it shall bear tort liability such as damages. Although fraudsters are often difficult to track down, insured persons can push for accountability for the relevant platforms and channels by calling the police and reporting to regulatory authorities.
For enterprises, if employees encounter such scams because the company handles medical insurance-related matters on their behalf, the company should pay attention to internal information management compliance. Many companies in Shenzhen handle social security and medical insurance matters for their employees collectively. Once internal information is leaked and exploited by scammers, the company may face compliance risks under the Personal Information Protection Law. It is recommended that companies establish a tiered management system for employee information to avoid exposing sensitive personal information to unnecessary personnel.
From a lawyer's perspective: prevention in advance is more important than recovering stolen assets after the fact.
In Shenzhen's judicial practice, the recovery rate of funds in telecom fraud cases is not encouraging. Fraud gangs often quickly transfer funds overseas or across multiple accounts, and even if the case is solved, victims may not fully recover their losses. Therefore, lawyers recommend focusing efforts on prevention in advance.
First, insured individuals should develop an awareness of official channels. Government departments such as medical insurance, social security, and taxation have fixed official platforms and hotlines for handling business, and will not ask you to take action through unfamiliar phone calls. When receiving a suspicious call, hanging up and proactively calling the official hotline to verify is the simplest and most effective preventive measure.
Second, be wary of the legal traps behind "information confirmation." Many scams do not directly ask for a transfer; instead, they first use "confirming to ensure the funds arrive" as a pretext to obtain your name, ID number, and bank card number, preparing for more targeted fraud later. According to Article 31 of the Anti-Telecom and Online Fraud Law, no unit or individual may illegally buy, sell, rent, or lend phone cards, bank accounts, payment accounts, etc. If an individual sells their bank card or phone card for a small fee, they may be guilty of the crime of assisting information network criminal activities and face criminal punishment.
Finally, enterprises should strengthen anti-fraud compliance training. As an economically vibrant city, Shenzhen has a highly mobile workforce, and newly hired employees are unfamiliar with local health insurance policies, making them easy targets for scams. Enterprises can regularly invite lawyers to give anti-fraud compliance lectures to help employees identify common scams, while also improving internal information protection systems to reduce their own legal risks.
Guangdong Zhiming Law Firm has long focused on telecom fraud, personal information protection, and corporate compliance, providing legal services to businesses and individuals in Shenzhen, including criminal complaints, criminal defense, and personal information protection compliance. In the face of ever-emerging scams, the law serves both as a weapon for accountability after the fact and as a guide for prevention beforehand.
