The common "collecting medicines at high price" cards at the hospital entrance turn out to be a major case involving hundreds of millions of dollars.
On January 27, CCTV News' "Focus Interview" exposed an illegal case of illegal reselling of medical insurance drugs and resale, with a value of up to 200 million yuan.
reported that in early 2022, the Medical Insurance Bureau of Pu'er City, Yunnan Province discovered abnormalities in the medical insurance cards of some local patients. has patients prescribed drugs for the treatment of kidney disease in many places and hospitals in a short period of time. analysis found that almost all of them were patients suffering from uremia or other special diseases or chronic diseases.
Just as the Pu'er Municipal Medical Insurance Bureau was launching an investigation, a pharmaceutical company reported: The Haikun Shenxi capsules it sold in Pu'er Hospital were once again flowing into other provinces for sale, which meant that these medical insurance drugs were 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 progresses, a criminal chain of illegal reselling of medical insurance drugs has surfaced.
Instigated patients to sell drugs
The amount involved was as high as 200 million
According to the police report, this insurance fraud case involved a total of 26 suspects, and eight drug warehouses were sealed. found illegally resold drugs weighing 9 tons and involving more than 3,000 varieties in Li's rental house in Kunming.
All this is closely related to the "recycled drugs" that are common near hospitals. The first-level drug dealers instigated and lured patients with chronic diseases to use their medical insurance cards to prescribe medicines in multiple hospitals, and then resold them to second-level drug dealers in Pu'er and Xishuangbanna. The second-level drug dealers then mail it to the third-level drug dealers in Kunming, and finally sell it at retail pharmacies in Shenzhen for a profit.
The police retrieved surveillance videos from the outpatient clinics of several large public hospitals in Pu'er City and found that after someone prescribed medicine in one hospital, they rushed to another hospital to prescribe medicine. These people can visit four or five hospitals a day until the entire woven bag is filled.
Using these people as clues, the police discovered three gangs of illegal drug dealers entrenched in Pu'er and Xishuangbanna. They instigated and lured patients with medical insurance cards for chronic diseases and special diseases to go to multiple hospitals to prescribe medicines and then recycle them at a higher price. Since the reimbursement ratio for the drugs prescribed to these patients is high, even if the drugs are collected at a higher price and then resold, there is still a large profit margin.
Subsequently, these medical insurance drugs were handed over to Li Mouxin in Kunming. He then sent medical insurance drugs to more than 20 provinces across the country in the name of tea and clothing. Among them, Ms. Zhang in Shenzhen has the largest shipment volume and the most frequent shipments. In just three months, the capital transaction amounted to nearly 7 million yuan.
Ms. Zhang's real name is Zhang Mouying. She is the legal representative of many pharmaceutical companies such as Shenzhen City Pharmacy Co., Ltd. Venture Branch, and has a large number of pharmacies under her name.
At this point, a criminal chain of illegal reselling of medical insurance drugs has completely emerged.
China has always maintained a high-pressure stance against the illegal reselling of medical insurance drugs. As early as 2014, the judicial interpretation on the handling of cases endangering drug safety made it clear that "violating national drug management laws and regulations, illegally dealing in drugs, and the circumstances are serious, shall be punished as illegal in accordance with the provisions of Article 225 of the Criminal Law" Convicted and punished for business crimes."
Currently, Li Mouxin is suspected of fraud, illegal business, and concealment of illegal gains, and is criminally detained by the public security organs in accordance with the law; Zhang Mouying is suspected of fraud and illegal business, and the public security organs take compulsory measures. Currently, the case is being further processed.
Multi-department joint rectification
Reselling medical insurance drugs has been jailed
At present, the Shenzhen Municipal Supervision Bureau has taken measures against the companies involved and opened an investigation.
On January 28, the "Shenzhen Market Supervision" public account announced that the Shenzhen Municipal Market Supervision and Administration Bureau had launched an investigation on January 10, 2024 for the Shenzhen-related companies mentioned in the report.
The Shenzhen Municipal Administration for Market Regulation also stated that after the report was broadcast, it immediately organized law enforcement personnel to rush to the scene, seal up the drug warehouse of the company involved, and seize 2 computer servers. The company involved in has suspended operations in 25 chain stores across the city. After on-site inspection, no drugs mentioned in the report have been found.
Similar cases were very difficult to crack down on in the past: designated hospitals did not share patient information; medicines were transferred from Yunnan to Shenzhen, almost half of China.
Now, 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 funds. Relevant departments have also cracked down harder on the reselling of medical insurance drugs.
According to the current policy, outpatients with chronic and special diseases can enjoy certain medical insurance benefits and payment limits every year, ranging from a few thousand yuan to hundreds of thousands of yuan depending on the disease. If the payment limit is not used up, it will generally not be transferred to the next level. One year. This has also led many patients to believe that their medical insurance benefits cannot be used up and that they “use them in vain”, and have a mentality of buying medical insurance drugs from hospitals and then reselling them to drug dealers for cash.
In order to severely crack down on refluxed drugs, regulatory authorities have strictly implemented the drug traceability system and established a long-term mechanism for drug supervision. According to the "Interpretation of Several Issues Concerning the Application of Laws in Handling Criminal Cases Endangering Drug Safety", those who knowingly purchase and sell drugs illegally by using medical insurance to defraud insurance, with an amount of more than 50,000 yuan, shall be required to cover up or conceal the crime in accordance with the criminal law. Convicted and punished.
The law severely punishes the behavior of "collecting drugs at high prices", and it also reminds every patient not to get involved in illegal and criminal activities just for small profits.
writing | Xiaomi
editor | Jiang Yun Jia Ting
operation | Han Jinrui
picture source | Visual China
