职工和药厂勾结、虚假开药 上海两家民营中医馆骗保1200余万元

Core Insights - The Shanghai police have dismantled a healthcare fraud ring involving a designated medical institution, which has committed over 50,000 fraudulent claims amounting to more than 120 million yuan in two years [1][13]. Group 1: Fraud Scheme Details - The fraud was orchestrated by the Yiyang Traditional Chinese Medicine Hospital, where internal staff colluded with external pharmaceutical companies to submit false claims [3][9]. - Investigations revealed that many insured individuals did not actually visit the hospital, yet their records showed multiple prescriptions and treatments [3][9]. - A specific employee, Zhao, was noted for bringing numerous neighbors to the hospital, resulting in over 300 visits in just six months [5]. Group 2: Investigation Findings - The police found that during visits, patients were not properly examined; instead, they were simply asked to sign and pay without any consultation [7]. - Data comparisons indicated that while only 2 to 3 patients were present, records showed over 10 visits, indicating a systematic fraud operation [9]. - Some staff members were involved in swapping expensive herbal medicines for cheaper alternatives, further complicating the fraud [11]. Group 3: Legal Actions and Outcomes - Following the identification of the fraud ring's structure, a major operation in October led to the arrest of 34 suspects, with additional arrests of 56 insured individuals in April [13]. - The fraud ring was led by a figure named Yan, who coordinated with stakeholders from the involved medical institutions to execute the fraudulent activities [13].