The common "** medicine" card at the entrance of the hospital actually hides a major case worth hundreds of millions of yuan.
On January 27, CCTV News's "Focus Interview" exposed an illegal case of illegal resale of medical insurance drugs and secondary sales, involving an amount of up to 200 million yuan.
According to reports, in early 2022, the medical insurance bureau in Pu'er City, Yunnan Province, found problems with the medical insurance cards of some patients locally. In these patients, doctors have prescribed some diagnoses and medication regimens that are inconsistent with their own, and some patients have even used a drug called "Kidney Kang Capsule". Some patients have been prescribed ** medication for patients with kidney disease in multiple places and hospitals in a relatively short period of time. Subsequent investigation revealed that the patients were all elderly men with severe chronic renal insufficiency. After careful analysis, we found that most of them were patients with uremia or other specific chronic diseases.
Just as the Pu'er Municipal Health Insurance Bureau began to investigate, a pharmaceutical company reported that the Haikun Kidney Xi capsules they sold at the Pu'er hospital had once again flowed into other provinces for sale, which meant that the drugs were being resold. The investigation by the National Health Insurance Bureau found that Haikun Kidney Xi capsules did flow into other provinces and were sold in the market. The Pu'er Municipal Medical Insurance Bureau immediately brought the drug company to the public security organ to report the case.
With the further development of the case, a criminal chain of illegal resale of medical insurance drugs was gradually revealed.
Encouraging patients to sell drugs.
The amount of cases involved is as high as 200 million.
*According to the report, 26 suspects were involved in the insurance fraud incident, and eight drug warehouses were sealed. In Li's rental house, there are dense piles of medicines, and all kinds of packages are scattered all over the place. In the rented house of Li in Kunming, 9 tons of illegal resale drugs involving more than 3,000 different varieties were found.
All of these are closely related to the "** medicines" that often appear around the hospital. In this huge pharmaceutical network, first-class drug dealers even use unscrupulous means to lure patients with chronic diseases to participate in order to obtain more patient medical insurance cards. Tier 1 pharmacists instigated and induced patients with chronic diseases to use their medical insurance cards to prescribe drugs at multiple medical institutions, and then resold them to Tier 2 pharmacists in Pu'er and Xishuangbanna. The path of the circulation of those "** drugs" is intricate, changing hands layer by layer, and finally converges to retail pharmacies in Shenzhen, which has become a source of benefits. The secondary drug dealer mails the drug to the **drug dealer in Kunming and then at the retail pharmacy ** in Shenzhen to get a profit.
* Surveillance footage was obtained in 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. After preliminary investigation, the man, known as the "black car driver", was a general doctor and a manufacturer and seller of woven bags. The group can go to four to five medical facilities a day until their woven bags are filled.
* Using these individuals as clues, three gangs of illegal drug traffickers in Pu'er and Xishuangbanna were successfully exposed. These gangs instigate and induce patients with medical insurance cards for chronic diseases and special diseases to buy drugs in multiple medical institutions, and then pass on the drug information to doctors through the Internet at a higher level, and charge high commissions to make huge profits. Given the high reimbursement rate for this group of patients, there is still huge potential for profit even if the price is increased and then resold.
Then, all this batch of medical insurance drugs were delivered to Li Mouxin in Kunming. In order to smoothly distribute medical insurance drugs, Ms. Zhang actively organized a team to work day and night in the packaging of tea and clothing. Again, in the name of tea and clothes, he sent medical medicines to more than twenty provinces across the country. Behind this capital exchange, Li Mouxin launched a clever financial operation. Out of all the shipments, Ms. Zhang in Shenzhen has the largest number of shipments and the most number of shipments. In just three months, the flow of funds reached nearly 7 million yuan.
Miss Zhang's real name is Zhang Mouying, she is the legal representative of a number of pharmaceutical companies under Shenzhen Metropolitan Pharmacy, and operates many pharmacies under her name.
By now, a criminal chain of illegal resale of Medicare drugs has been fully exposed.
China has always taken a strict stance against the illegal resale of medical insurance drugs. This is closely related to the escalating drug safety accidents in recent years. As early as 2014, the judicial interpretation on the handling of cases endangering drug safety clearly pointed out: "Anyone who violates the national drug administration laws and regulations and illegally deals in drugs, and the circumstances are serious, will be convicted and punished for the crime of illegal business operation in accordance with the provisions of Article 225 of the Criminal Law".
Now, Li Mouxin has been taken into criminal detention by the public security department in accordance with the law for being involved in fraud, illegal transactions and concealment of illegal gains; Zhang Mouying was arrested by the public security organs in accordance with the law on suspicion of illegal business. Zhang Mouying has been coercive by the public security department because she is involved in fraud and illegal business activities. The nature of both cases was the crime of fraud, the crime of illegal possession of drugs, and the crime of illegal manufacture of firearms. At this stage, the case is still in the advanced processing stage.
Multiple departments are working together to reorganize.
Sentences have been imposed for reselling Medicare drugs.
Now, the Shenzhen Municipal Administration has implemented corresponding measures against the enterprises involved and has begun a formal investigation.
On January 28, "Shenzhen Market Regulation"** announced that the Shenzhen Municipal Administration for Market Regulation had launched a formal investigation into the companies involved in Shenzhen mentioned in the report on January 10, 2024.
The Shenzhen Municipal Administration for Market Regulation also made it clear that once the report began to be broadcast, they would immediately organize law enforcement officers to go to the location of the incident, seal up the drug warehouses of the companies involved, and seize two computer servers. After on-site inspection, the market regulators found that the enterprises involved had a number of violations, including unclear inventory and incomplete sales records. The companies involved decided to suspend their operations in 25 chains across the city. After on-site inspection, we found that the inventory in the drug warehouse was in good condition, and no drugs mentioned in the report were found so far. After field testing, no drugs mentioned in the report have been found.
In the past, the fight against this situation was very difficult: patient information was not exchanged between the various designated hospitals; There is very little communication between the doctor and the **. With the acceleration of medical informatization, more and more medical institutions have begun to use information systems to deal with problems encountered in daily work, such as prescription management and medication consultation. Drugs flow from Yunnan to Shenzhen, and are distributed in almost half of China.
Now, with the launch of the national unified medical insurance information platform, all the settlement information of the insured can be uploaded and summarized on the platform, which provides a solid foundation for the intelligent supervision of medical insurance. In the construction of medical insurance informatization, an important task is to solve the problem of "expensive medical treatment", and the most effective way to solve this problem is to reduce the drug **, so that patients can buy cheap drugs. As a result, the relevant authorities have taken more severe measures to crack down on the reselling of medical insurance drugs.
According to the current medical policy, patients with chronic special diseases in outpatient clinics are eligible for a certain amount of medical insurance benefits every year, which can range from a few thousand yuan to hundreds of thousands of yuan depending on the type of disease, and are usually not carried over to the next year if the payment limit has not been exhausted. In order to make full use of medical insurance benefits, some patients are looking for ways to monetize. This situation has also led many patients to develop a mentality that they believe that the benefits of Medicare are not exhausted, so they choose to buy Medicare drugs from hospitals and then resell them to pharmacists to make a profit.
In order to strictly crack down on drug reflux, the regulatory authorities have strictly implemented the drug traceability system and established a lasting and effective drug supervision mechanism. According to the provisions of the "Interpretation on Several Issues Concerning the Application of Law in the Handling of Criminal Cases Endangering Drug Safety", those who knowingly purchase drugs through medical insurance fraud and illegally purchase and sell them in an amount exceeding 50,000 yuan shall be convicted and punished for concealing or covering up their crimes in accordance with the Criminal Law.
The law imposes severe penalties for "** collecting drugs" and is a wake-up call for every patient, reminding them that they should not be involved in illegal and criminal acts in pursuit of small profits.