针对各类医保骗保犯罪，特别是隐形的非接触式犯罪，必须严厉打击，依法惩处。据统计，2024年，全 国法院一审审结医保骗保犯罪案件1156件2299人，一审结案数同比增长131.2%，挽回医保基金损失4.02 亿余元。最高人民法院、最高人民检察院、公安部等部门还专门出台指导意见，准确认定医保骗保犯 罪，进一步健全协同配合机制。 医保基金是人民群众的"看病钱""救命钱"。日前，最高人民法院发布4件依法严惩医保骗保犯罪典型案 例，对空挂床、病历造假、篡改检验报告等医保骗保行为予以严惩，释放全链条打击治理医保骗保犯罪 的信号。 医保骗保手段常翻新，隐蔽性更强。有的犯罪分子另辟蹊径，通过社交软件联系上下家收购、销售"医 保回收药品"。这些犯罪分子组织有序、分工明确，通过非接触式手段，倒卖医保骗保药品非法牟利， 不仅造成医保基金损失，还有大量药品得不到妥善保管而浪费。更严重的是，部分变质药品再次流入销 售环节，形成"回流药"黑色产业链，危害人民群众身体健康。 （文章来源：经济日报） 随着医保改革深入推进，惠民政策不断深化，需合力守住医保基金安全底线。医保骗保犯罪高发、多 发，暴露出医保监管有待完善。对于新问题新现象，一方面 ...

Core Points - The new regulation mandates that from July 1, 2023, medical institutions must scan drug traceability codes before settling with medical insurance funds, enhancing drug safety [1] - By January 1, 2026, all medical institutions are required to fully collect and upload drug traceability codes, establishing a comprehensive tracking system for pharmaceuticals [1] - The traceability code acts as a unique electronic identity for each drug, ensuring that each box of medication has a single sales record, thus preventing counterfeit and swapped drugs [1] Industry Impact - The integration of drug traceability codes with medical insurance is significant for public drug safety, effectively combating issues like "returned drugs" and fraudulent transactions [2] - The traceability system allows for precise monitoring of high-priced drugs, ensuring they are used appropriately and reach the patients in need [2] - The National Medical Insurance Administration has already demonstrated the effectiveness of this system by investigating the traceability codes of specific drugs, thereby safeguarding both drug safety and insurance funds [2] Public Engagement - Consumers are encouraged to actively participate in ensuring their own drug safety by following six key practices when purchasing medications, including verifying the presence of traceability codes and scanning them for authenticity [3] - The promotion of drug traceability codes is essential, with the goal of making the scanning process a standard practice in every drug transaction [3] - Strengthening regulatory measures around drug traceability codes will help close potential loopholes and enhance public health protection [3]

Core Viewpoint - Guangxi has officially implemented a "no code, no settlement" policy for designated retail pharmacies under the medical insurance system, requiring pharmacies to scan traceability codes for medical insurance drug sales to ensure safety and prevent counterfeit drugs [1][2] Group 1: Implementation Details - All designated retail pharmacies in Guangxi must scan traceability codes and upload information to the medical insurance information platform for drug settlement [1] - The traceability code acts as an "electronic ID" for each drug, assigned from production to sales, allowing for quick identification of counterfeit or substandard drugs [1] - As of now, Guangxi has collected 940 million traceability codes covering 19,000 medical institutions [1] Group 2: Consumer Protection Measures - The "no code, no settlement" policy will not affect the purchasing process for insured individuals or the normal reimbursement of medical insurance [1] - For drugs that have not yet been assigned codes, they can be temporarily included in a "no code library" for real-time data collection and review [1] - Consumers can verify their purchase information through the National Medical Insurance Bureau's official app by scanning the traceability code [2] Group 3: Impact on Drug Safety and Fraud Prevention - The implementation of this policy is expected to effectively curb the influx of counterfeit and "returned" drugs into the market, enhancing public safety [2] - It will also utilize big data analysis to combat various fraudulent activities related to medical insurance funds, ensuring safer and more efficient use of these funds [2]

Core Viewpoint - The case marks the first successful lawsuit initiated by the Shanghai Medical Insurance Center for the recovery of medical insurance funds, highlighting the importance of safeguarding public health funds and improving their utilization efficiency [1][5][8]. Group 1: Case Background - The case involves a traffic accident where a taxi driver was found fully responsible for injuring a pedestrian, leading to medical expenses of nearly 150,000 yuan, of which over 40,000 yuan was covered by the medical insurance fund [3][4]. - The pedestrian subsequently sued the taxi company and the insurance company for compensation, resulting in a court ruling for the insurance company to pay over 160,000 yuan, but the recovery of the medical insurance fund was not addressed in the initial ruling [4][5]. Group 2: Legal Framework and Implications - The ruling is based on the newly implemented Shanghai Medical Insurance Regulations, which clarify the rights of the medical insurance agency to pursue recovery of funds paid out for medical expenses that should be covered by third parties [6][7]. - The regulations specify the scope of medical insurance fund usage and establish the medical insurance agency's role as the recovery entity, which is crucial for ensuring accountability and effective fund management [6][7]. Group 3: Future Directions - The case is expected to serve as a precedent for future similar cases, aiming to clarify the rights and responsibilities related to the recovery of medical insurance funds [8][9]. - The local authorities plan to enhance the efficiency of fund recovery through improved information sharing and non-litigation mechanisms, promoting a societal consensus on the return of funds paid by the medical insurance [9].