严查回流药！国家医保局公布十起典型案例

Core Viewpoint - The National Healthcare Security Administration (NHSA) has announced ten typical cases of fraud and illegal activities in the pharmaceutical sector, highlighting the ongoing efforts to combat drug-related fraud through the use of drug traceability codes [1][2] Group 1: Fraud Cases - The ten typical cases involve activities such as the resale of medical insurance drugs and the swapping of drugs across various regions in China, including Inner Mongolia, Shandong, Chongqing, Sichuan, Guizhou, Henan, Ningxia, Zhejiang, Heilongjiang, and Fujian [1] - Specific cases include the resale of medical insurance drugs by community health service stations and pharmacies, with notable instances in Ulanqab, Dezhou, Dazhu, and other locations [1] Group 2: Role of Drug Traceability Codes - Drug traceability codes have played a crucial role in identifying fraudulent activities, with over 53 billion drug traceability codes collected nationwide [2] - An example includes the Ulanqab community health service station, where 72 drug traceability codes were found to have duplicate settlements, leading to an investigation that uncovered the resale of drugs by medical staff [2] Group 3: Impact on Insurance Funds - The fraudulent activities have resulted in significant losses to the medical insurance fund, with one case in Hangzhou causing a loss of approximately 439,854.73 yuan due to the illegal resale of drugs by insured individuals [2] - The NHSA emphasizes the importance of compliance with drug procurement and settlement processes to protect the integrity of the medical insurance system [2]