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If the medical insurance fund is living water to ensure good health, then the drug dealers are ants digging holes in the dam of this reservoir, and under their turnover, through the "washing medicine" link of buying and selling drugs in the medical insurance, the medical insurance funds are diverted from the pooled account to the wallets
of the stakeholders.
Every three or five days, a batch of couriers had to be packed and sent, and the place where I lived was stacked with more than 5,000 boxes of medicines worth nearly 160,000 yuan.
.
.
This is not the storehouse of some small pharmacy, but the daily life
of a "drug dealer".
Recently, the CCTV news channel "Rule of Law Online" disclosed a major case
of cross-provincial investigation.
In the process of clearing up the "reflux medicines", the Nanchang police took a suspicious "drug dealer" at the entrance of the hospital as the line, and after eight months of continuous combat, finally overturned a criminal network
involving nearly 100 people from 22 provinces and cities, involving more than 200 million yuan in the case of buying and selling medical insurance drugs.
The illegal benefit chain of "reflux drugs" is generally that the prescriber uses the identity of a medical insurance insured person, buys drugs from hospitals or designated institutions, and then resells them to drug dealers or related intermediaries, and then transfers them to pharmacies and clinics again, and then sells them to consumers
.
"Buying drugs from hospitals, circulating them, and returning them to the drug sales scene is equivalent to 'washing' drugs by illegal means
.
" For patients, it is good to be a real drug, if it is a fake drug and inferior drug, it will also bury hidden dangers
for the safety of patients' medication.
A pharmaceutical industry source said
.
In the context of universal medical insurance, if the medical insurance fund is a reservoir that maintains a healthy life for everyone, then similar "washing medicine" behavior, from individual evil to team crime, involves tens of thousands to hundreds of millions of dollars, which is tantamount to "stealing water" to water their own land, forming "ant nests"
of different sizes on the pool.
01 22 provinces and cities, more than 3,000 pharmacies.
.
.
How big is the "hole" poked out?
.
.
How big is the "hole" poked out?
In the "washing medicine" chain of swiping medical insurance cards - prescribing drugs - receiving drugs - selling medicines, it is full of fake patients, fake medical conditions, fake treatments and fake bills, from economic crimes to criminal crimes, there is always a crime suitable for medical insurance "stealing water" people
.
In the process of cutting out the medical insurance gap, who is the link in selling medicine? Judging from the compilation of publicly reported cases, most of the time "drug sellers" are mainly elderly groups and groups with their own diseases
.
In 2018, the Jiangbei Branch of the Ningbo Municipal Public Security Bureau arrested a "medicine washing" industrial chain, and the people involved in the case, in addition to drug dealers, the remaining more than 50 drug sellers were middle-aged and elderly people
.
The largest circulation in the "washing" link is chronic treatment drugs mainly for the treatment of hepatitis and diabetes, which is also the type
of drugs that street drug dealers are keen to buy.
Many elderly people themselves have related diseases, and it is easy to become their fixed home after one or two contact with drug dealers, and in this case in Ningbo, the price of drugs bought and sold by relevant personnel was as high as more than 900,000 yuan
.
From the perspective of "prescribing medicine" on the "washing medicine" chain, if the medical retention card user has the intention to commit a crime, it will accumulate and it is almost impossible to prevent
.
In 2021, a couple in Zhenjiang City, Jiangsu Province attracted the attention of the local police, and in the absence of major diseases, the two prescribed nearly 400,000 yuan of drugs a year in local hospitals and community centers, and ran to several pharmacies
almost every day.
After stripping back the cocoon, the Zhenjiang police found that behind these two people, there are more than 300 local people who have such a situation of false opening without disease and multiple opening of disease, and so far, more than 20 interrelated medical insurance fraud gangs
have been identified.
What is shocking is that behind the "small, scattered and chaotic" individual drug sellers, this washing chain is scattered in 11 provinces in China, and more than 100 pharmacies are involved in reselling and selling stolen goods, which is obviously only the tip
of the iceberg in the industrial chain.
The phenomenon of "drug dealers" has a long history, and the media reported it as early as 20 years ago, but in recent years, the number of cases disclosed in various places has involved a wide range of provinces, a wide range of cases, and the amount of money is still terrifying
.
Behind every greedy drug prescriber, there may be multiple drug dealers, and behind these drug dealers are middlemen, pharmacies and other distribution institutions, like a large network of close interests, firmly adsorbed on the
medical insurance fund.
After the "stealing" from Medicare, where did those drugs go?
In 2019, the Mudanjiang Public Security Bureau in Heilongjiang Province cracked a case involving as much as 150 million yuan
.
According to the relevant case-handling police, the "reflux drugs" in the case at that time were mainly sold to the three provinces of Heijiliao and Inner Mongolia, and a small amount was sold to Hebei, Henan and other places
.
More than 3,000 small and medium-sized pharmacies in Heilongjiang Province have maintained long-term relations with the drug dealer Han in the case, including more than 700 in Harbin, more than 300 in Qiqihar, and more than 200 in Mudanjiang, including more than 40 in Mudanjiang District, and the rest of the drugs are mainly sold to villages around the city
.
In the case of Ningbo mentioned in the aforementioned article, drugs collected from the elderly at low prices were sold by drug dealers to their families, and then changed hands and finally flowed into rural areas in the mainland
.
In the Zhenjiang case, the police introduced that in this case, some of the "drug dealers" were themselves pharmaceutical salespeople, so they were able to master a large number of pharmacy resources, and the team of "washing medicines" was often relatives and fellow villagers
.
The stolen pharmacies at the end of the chain are scattered across the country, as are also pharmacies in rural areas where regulation is relatively lax
.
An industry insider told the manager of E Drug that after the middleman buys these drugs at a low price, simply sorts and packs them, and then sells them at a higher price, such drugs are often not recorded in the account, but operate
outside the pharmacy operating system.
In many areas, the proportion of medical insurance payment is not high, and relatively cheap reflux drugs have market demand and living space
.
Under the wrapping of the entire interest chain, the "wash" from bottom to top also develops from a small spot to a stain, and finally forms a medical insurance black hole
.
02 In addition to the "life-saving money" loophole, security is also a big problem
In addition to the "life-saving money" loophole, security is also a big problemIn addition to wasting medical insurance funds, another drawback of "washing medicine" cannot be ignored, that is, drug safety issues
.
When drugs circulate through illegal channels such as patients, drug dealers, and pharmacies, the quality of drugs is often difficult to guarantee
.
Xu Yucai, former deputy director of the Shanyang County Health Bureau in Shaanxi Province, said that the Drug Administration Law stipulates that all medical institutions, including pharmacies, can only buy drugs from enterprises with drug business licenses or drug production licenses, and it is illegal to buy them from individuals
.
Because the channel is illegal, it is easy to become a "channel"
for the trade of counterfeit and inferior drugs.
The Drug Administration Law also has clear requirements
for the storage of medicines.
General drugs require room temperature storage or dark storage, the temperature can be controlled at 20 °C ~ 30 °C, some need to be stored in the shade, the temperature can not exceed 20 °C, and the requirement of refrigerated storage, generally require 4 ~ 8 °C environment
.
Even if the drug is real, there is a danger of deterioration after it is separated from the specified storage conditions, and the "life-saving drug" is likely to become a "life-saving drug"
.
Xu Yucai stressed that while centralized procurement has brought down the prices of many drugs in medical insurance, the resale of medical insurance drugs has become more rampant because of the larger interest space
.
In the Mudanjiang case, which involved as much as 150 million yuan, Zhang Lihu, a police officer of the Economic Investigation Brigade of the Yangming Public Security Sub-Bureau of Mudanjiang City, said when introducing the arrest, "The scene is full of medicines on the ground, in front of the large floor-to-ceiling window, the sunlight shines directly on insulin, tetrabacterin tablets and other drugs that need to be refrigerated, the indoor temperature is 25 degrees Celsius, and the storage environment is very worrying!" ”
In addition, once illegal channels for drug circulation are established, counterfeit drugs, fake and inferior drugs, and expired drugs are almost impossible to prevent
.
From the perspective of acquisition channels, many elderly people sell drug dealers themselves are their own drugs that they can't finish eating or prescribe too much, for drug dealers these drugs are often lower cost, but close to expiration or has already expired is a high probability event
.
What's even more unscrupulous is that some drug dealers will go out of their way to recycle some chronic disease medicine boxes at low prices, and the whereabouts of these boxes and expired drugs are worrying
.
When handling similar cases, the police have repeatedly reminded the public that when purchasing drugs, they should pay attention to whether the number, production date and other labels on the inner packaging and the outer packaging of the drugs are consistent.
Members of the public who purchase this medicine should report it immediately
.
In order to curb such behaviors, Fujian and Xiamen and other places have issued the Notice on Strengthening the Disposal of Drug Packaging, requiring all designated medical institutions to "dismantle and dismantle" drug packaging on the premise of ensuring the safety and effectiveness of drugs
.
On March 4, 2022, the Supreme People's Court and the Supreme People's Procuratorate jointly issued the Interpretation on Several Issues Concerning the Application of Law in the Handling of Criminal Cases Endangering Drug Safety, which was officially implemented
on March 6.
Those who knowingly purchase or sell drugs purchased by medical insurance fraudulently for an amount of more than 50,000 yuan shall be convicted and punished for the crime of concealing or concealing the proceeds of crime; Those who instruct, instigate or instruct others to use medical insurance to purchase drugs fraudulently, and then illegally purchase or sell them, shall be convicted and punished as fraudulent, focusing on punishing "middlemen" who resell medical insurance and fraudulent insurance drugs, and cutting off the "reflux medicine" industrial chain
.
In recent years, local medical security departments have also cooperated with the Market Supervision Administration and public security departments to carry out joint law enforcement actions to track key drugs for a long time
.
Combing through different cases in different places shows that big data screening is playing an important role
in such cases.
In the relevant case in Ningbo mentioned in this article, it was big data analysis that found that an insured person dispensed drugs frequently and in large quantities, which did not match his medical history, so that the regulatory authorities grabbed this tail and led out the "shuo rat" team
behind.
Before criminals surface, it is difficult to distinguish the difference between normal medical treatment and "washing medicine" from the surface, and through big data screening, abnormal behaviors can be locked in a timely and accurate manner to stop "medical insurance wool"
.
At the 2022 national special rectification action to combat fraud and insurance fraud, the notice pointed out that in 2021, a total of 708,000 designated medical institutions were inspected, 411,000 were investigated and dealt with, and 23.
4 billion yuan of medical insurance funds were recovered.
The medical insurance and health departments assisted the public security organs in detecting more than 2,031 criminal cases of defrauding medical insurance funds, arresting more than 5,002 criminal suspects, recovering 510 million yuan of medical insurance funds involved in the case, and detecting 349 cases of illegal operation of medical insurance drugs, involving a total amount of 1.
5 billion yuan
.
The medical insurance fund is everyone's "life-saving money", and it must not be allowed to be driven by profits to form an underground industry and black ash market
.
