National medical insurance** is the people's medical treatment money and life-saving money, but in recent years, medical insurance fraud cases have occurred from time to time. According to a CCTV news report on January 28, recently, Yunnan ** seized a case of insurance fraud worth 200 million yuan. At present, legal measures have been taken against the people involved in the case, and the case is being further handled.
In order to reduce the drug burden of patients with special diseases and chronic diseases, the coverage of national medical insurance policies is becoming more and more extensive, and the reimbursement ratio of many drugs has been further increased. However, in the above-mentioned news incident, some patients with chronic disease medical certificates purchased medical insurance drugs at the reimbursement price in hospitals, resold them to drug dealers, and finally entered the shelves of terminal pharmacies.
This "fantasy journey" experienced by medical insurance drugs can be described as a process of "whitewashing". In this chain, some holders of health insurance cards and chronic disease medical certificates are instigated and lured by drug dealers, ignoring the importance of everyone guarding the health insurance dam for the sake of small profits. In reality, we see drug dealers "moving" around the hospital from time to time, looking for patients under the banner of "collecting medicine". Through this case, medical insurance card holders should be aware that participating in drug reselling fraud is suspected of violating the law, and they should be extra vigilant when seeking medical treatment on a daily basis.
The behavior of the drug dealers in the middle layer by layer, the terminal sellers who provide "exports" for the illegal resale of medical insurance drugs, not only disrupts the order of medical insurance drug sales, but also embezzles medical insurance funds and dissolves the beneficial attributes of the relevant system. In addition, the reflux medical insurance drugs sold through pharmacies may be difficult to ensure the quality due to the necessary temperature and humidity for drug storage, which will pose a threat to the safety of patients.
The attitude of the relevant parties in fulfilling their duties and resolutely cracking down on insurance fraud is worthy of recognition, but it is also necessary to further reflect on the problems exposed. For example, if some patients participate in insurance fraud activities, does it mean that the relevant laws are not popularized? Whether drug dealers induce medical insurance card holders to prescribe medical insurance drugs with high reimbursement ratios in multiple hospitals indicates that the daily supervision of drugs with high reimbursement ratios needs to be improved; Many drug dealers transport drugs through express delivery in the name of tea and clothing, which to a certain extent indicates that some express delivery companies have not implemented the express mail collection and inspection system. In addition, why can unofficial drugs be sold through regular pharmacies? This is also worth pondering.
These problems are a kind of enlightenment for the relevant parties to improve medical insurance and drug supervision, and only by examining the loopholes, in-depth analysis, and weaving a dense network can we hope to reduce the occurrence of such cases. The Interpretation of the Supreme People's Court and the Supreme People's Procuratorate on Several Issues Concerning the Application of Law in Handling Criminal Cases Endangering Drug Safety specifically stipulates the criminal acts of medical insurance fraud, proposes a full-chain crackdown, and focuses on punishing middlemen and terminal sellers with the largest illegal profits. This provides a detailed basis for severe punishment. At the same time, the "Measures for the Convergence of Drug Administrative Law Enforcement and Criminal Justice" issued by relevant departments also has the effect of "weaving a network".
From a certain point of view, guarding medical insurance** is to protect the health of the people, and we must not tolerate any leakage and stitches.