The commonplace "** receiving medicine" card at the entrance of the hospital turned out to be a big case of hundreds of millions of yuan.
On January 27, CCTV News "Focus Interview"** An illegal case of illegal reselling of medical insurance drugs and reselling them for secondary sale, involving a value of up to 200 million yuan.
According to the report, at the beginning of 2022, the Yunnan Pu'er Municipal Medical Insurance Bureau found that the medical insurance cards of some local patients were abnormal. Some patients have been prescribed drugs for kidney disease in many places and hospitals in a short period of time. The analysis found that almost all of them were patients suffering from uremia or other types of special or chronic diseases.
Just as the Pu'er Municipal Medical Insurance Bureau launched an investigation, a pharmaceutical company reported:The Haikun Kidney Xi capsules sold in Pu'er Hospital were once again sold in other provinces, which means that these medical insurance drugs are being resold. The Pu'er Municipal Medical Insurance Bureau immediately took the pharmaceutical company to report the case to the public security department.
As the case deepened, a criminal chain of illegal reselling of medical insurance drugs surfaced.
Instigating patients to sell medicines
The amount involved is as high as 200 million
According to the ** report, this insurance fraud case involved a total of 26 criminal suspects and seized eight drug warehouses. In Li's rental house in Kunming, it was found that 9 tons of illegal reselling drugs involving more than 3,000 varieties were found.
All this is closely related to the common "** drugs" near the hospital. A first-class drug dealer instigated and lured patients with chronic diseases to use their medical insurance cards to prescribe drugs in multiple hospitalsResold to second-level drug dealers in Pu'er and Xishuangbanna. The second-level drug dealer then mailed it to the ** drug dealer in Kunming, and finally made a profit in the retail pharmacy ** in Shenzhen.
* Surveillance footage was retrieved from the outpatient clinics of several large public hospitals in Pu'er City, and it was found that someone had finished prescribing medicine in one hospital and then rushed to another hospital to prescribe it. These people can go from hospital to hospital four or five a day until the entire woven bag is filled.
Using these people as clues, three illegal drug dealer gangs entrenched in Pu'er and Xishuangbanna were identifiedThey instigated and lured patients with medical insurance cards for chronic diseases and special diseases to go to various hospitals to prescribe medicines, and then markup**. Due to the high reimbursement rate of these patients' prescriptions, even if the drug is charged at a higher price and then reselled, there is still a lot of profit margin.
Subsequently, these medical insurance drugs were handed over to Li Mouxin in Kunming. In the name of tea and clothing, he sent medical insurance drugs to more than 20 provinces across the country. Among them, the largest number of shipments and the largest number of shipments is Ms. Zhang in Shenzhen. In just three months, the capital exchange is nearly 7 million yuan.
Miss Zhang's real name is Zhang Mouying, and she is deepThe legal representative of a number of pharmaceutical companies such as Shenzhen City Pharmacy *** Chuangye Branch, has a large number of pharmacies under his name.
At this point, a criminal chain of illegal reselling of medical insurance drugs has completely surfaced.
China has maintained a high-pressure posture against illegal reselling of medical insurance drugs. As early as 2014, in the judicial interpretation on the handling of cases of endangering drug safety, it was made clear that "violating national drug administration laws and regulations,Where the circumstances are serious, it shall be convicted and punished as the crime of illegal business operation in accordance with the provisions of Article 225 of the Criminal Law."
At present, Li Mouxin is suspected of fraud, illegal business, covering up and concealing illegal gains, and is criminally detained by the public security organs in accordance with the law; Zhang Mouying was suspected of fraud and illegal business operation, and was taken compulsory measures by the public security organs. At present, the case is being further handled.
Multi-departmental joint rectification
Reselling medical insurance drugs has been criminalized
At present, the Shenzhen Municipal Supervision Bureau has taken measures against the enterprises involved and filed a case for investigation.
On January 28, "Shenzhen Market Supervision"** released a message saying that for the Shenzhen enterprises involved in the report,The Shenzhen Municipal Administration for Market Regulation has opened an investigation into it on January 10, 2024.
At the same time, the Shenzhen Municipal Administration for Market Regulation said that after the report was broadcast, law enforcement officers were organized to rush to the scene as soon as possible, and the drug warehouse of the enterprise involved was sealed and 2 computer servers were seized. The 25 chain stores of the enterprises involved in the city have suspended operations. After on-site inspection, no drugs mentioned in the report were found.
Similar cases have been very difficult to crack down in the past:Patient information is not exchanged between designated hospitals; From Yunnan to Shenzhen, almost half of China has been transferred.
Nowadays, with the launch of the national unified medical insurance information platform, the settlement data of all insured persons can be uploaded and collected through the platform, laying the foundation for the intelligent supervision of medical insurance. The relevant departments have cracked down on the reselling of medical insurance drugs even stronger.
According to the existing policy,Outpatient patients with chronic diseases can enjoy a certain amount of medical insurance treatment payment limit every year, ranging from thousands of yuan to hundreds of thousands of yuan for different diseasesIf the payment limit is not used up, it will not be carried over to the next year. This also leads many patients to think that the medical insurance treatment is not exhausted, "no need for nothing", and there is a psychology of buying medical insurance drugs from the hospital and then reselling them to drug dealers for cash.
In order to crack down on reflux drugs, the regulatory authorities strictly implement the drug traceability system and establish a long-term mechanism for drug supervision. According to the "Interpretation on Several Issues Concerning the Application of Law in Handling Criminal Cases of Endangering Drug Safety", it is pointed outWhere it is clearly known that drugs purchased through medical insurance fraud are illegally purchased or sold, and the amount is 50,000 yuan or more, it shall be convicted and punished for the crime of covering up or concealing criminal proceeds in accordance with the Criminal Law.
The law severely punishes the behavior of "receiving medicine", and it also reminds every patient that they must not be involved in illegal and criminal activities for the sake of small profits.
Written by丨Xiaomi.
Edited by Jiang Yun Jia Ting.
Operated by Han Jinrui.
Photo source: Visual China.