哪里出问题，就从哪里发力。针对这些骗保案件的特点，要加大惩处力度，精准发力，堵住漏洞，如医 保、市场监管等部门需强化联动，运用大数据等技术手段，对定点药店的结算数据实时预警、精准筛 查、突击检查，让违规者无所遁形。在这一过程中，监管必须全链条"长牙带刺"，惩戒必须"伤筋动 骨"。一旦查实，对违规药店应坚决取消其定点资格，并处以重罚；对涉事企业也要严惩，令其吐出非 法利润。同时，也要不断创新探索医保个人账户"活化"路径，如推行家庭共济、试水衔接长期护理保险 等，充分提升资金使用效率。 医保基金的每一分钱，都需要精准用在健康保障的"刀刃"上。护好守紧这些"看病钱""救命钱"，就是守 护我们的安康生活。共同织牢医保基金的"安全网"，让"救命钱"真正用于救命，才是对自己负责、对社 会负责。 海报制作：陈泉伊、刘羿佟 这种恶劣做法，不仅"刷"出了法律风险，也"刷"出了层层失守。从报道可知，上海警方公布的一起案例 中，涉事医院管理层、医生、"黄牛"等内外勾结，通过"黄牛"带诊、虚假诊疗等方式，两年内骗保记录 达到5万余条，骗取国家医保基金超过1200万元。仅这一案例的"黑色利益链"上，就有120多名犯罪嫌疑 人被采取刑事 ...

国家医保局公布5起个人骗取医保基金典型案例 中新网12月1日电 据国家医保局网站消息，为进一步强化全民医保法治意识、深化警示教育效果，巩固 对欺诈骗保行为的高压态势，彰显守护医保基金安全的坚决态度，国家医保局现发布第四期5起个人骗 取医保基金典型案例。 2025年1月，河北省秦皇岛市医保部门收到相关部门移交的线索后，立即会同秦皇岛市港航公安机关开 展联合调查。经查，2023年2月至2024年12月，参保人关某为获取非法利益，通过刘某、孟某某、贾某 某、玄某某收集社会保障卡70余张，关某利用收集的这些社会保障卡，以代购药名义先后在秦皇岛市21 家医疗机构开具司美格鲁肽并骗取医保基金报销12万余元。随后，关某将购买的这些司美格鲁肽，通过 邮寄方式向湖北省武汉市、河南省开封市、天津市等地销售获利。 2025年5月13日，港航公安局将关某、刘某、孟某某、贾某某、玄某某5名犯罪嫌疑人移送海港区人民检 察院审查起诉。目前，案件正在海港区人民检察院审查起诉中。经查，关某为公职人员，2025年5月26 日已将关某案件同步移送秦皇岛市纪检监察机关。 案例二 安徽省芜湖市参保人肖某倒卖医保药品骗保案 2024年8月，安徽省芜湖市 ...

央视网消息：医保基金作为人民群众的"看病钱""救命钱"，绝不容许任何形式的侵占、挪用与骗 取。为进一步强化全民医保法治意识、深化警示教育效果，巩固对欺诈骗保行为的高压态势，彰显守护 医保基金安全的坚决态度，国家医保局现发布第四期5起个人骗取医保基金典型案例。 案例一 河北省秦皇岛市关某等5人冒名就医和倒卖医保药品骗保案 2025年1月，河北省秦皇岛市医保部门收到相关部门移交的线索后，立即会同秦皇岛市港航公安机 关开展联合调查。经查，2023年2月至2024年12月，参保人关某为获取非法利益，通过刘某、孟某某、 贾某某、玄某某收集社会保障卡70余张，关某利用收集的这些社会保障卡，以代购药名义先后在秦皇岛 市21家医疗机构开具司美格鲁肽并骗取医保基金报销12万余元。随后，关某将购买的这些司美格鲁肽， 通过邮寄方式向湖北省武汉市、河南省开封市、天津市等地销售获利。 2025年5月13日，港航公安局将关某、刘某、孟某某、贾某某、玄某某5名犯罪嫌疑人移送海港区人 民检察院审查起诉。目前，案件正在海港区人民检察院审查起诉中。经查，关某为公职人员，2025年5 月26日已将关某案件同步移送秦皇岛市纪检监察机关。 案例二 安 ...

央视网消息（焦点访谈）：诊所、药店、中医馆、社区卫生服务站等医保定点医药机构大家并不陌生，百姓有个头疼脑热，去这些地方看病或者拿药， 可以通过医保报销，但是，有人却把这些场所当成了"提款机"，把治病救人的医保基金当成了"唐僧肉"，打起了歪主意。记者调查发现，一些看似普通、近 在身边的小诊所里，却藏着大猫腻。 上海警方近期公布一起案例，上海市长宁区的三针堂中医门诊部是一家民营中医馆，几乎每周都有不同的老人来这里"就诊"。这些老人在中医馆停留半个多 小时，便匆匆乘车离开。三针堂中医门诊部是一家医保定点医疗机构，规模并不大。但是，从医保诊疗数据上看，却存在着诸多疑点。 上海市公安局虹口分局刑侦支队六队队长王臻："早上八点半开始营业，到十点之间一个人没有，十点到十点半之间一下出来20个人就诊记录，十点半之后 到中午十二点又没有人。" 上海市公安局虹口分局刑侦支队六队民警叶寅曜："开的医保数据是一样的，包括药的信息是一模一样的。" 调查画面显示，三名老人被人带进这家中医馆，挂号之后，就直接进入一间名为"中医预防保健科"的诊室。 令人意外的是，严某还指使医疗机构内部人员，利用自己和家人的医保卡大肆套取国家医保基金。调查数 ...

Core Viewpoint - The National Medical Insurance Administration emphasizes a "zero tolerance" policy towards fraudulent activities related to medical insurance funds, highlighting the importance of safeguarding public interests and maintaining the integrity of the medical insurance system [1]. Group 1: Fraud Cases Summary - Case 1: In Jiangsu Province, an individual named Jing exploited special disease insurance benefits to fraudulently acquire and resell high-priced medications, resulting in a loss of over 280,000 yuan to the medical insurance fund [2][3]. - Case 2: In Guizhou Province, Zhao organized a scheme to instruct patients to overprescribe medications, leading to a total loss of approximately 282,392.52 yuan from the medical insurance fund [3][4]. - Case 3: In Jiangxi Province, an individual named Xiao used another person's social security card to fraudulently obtain and sell medications, causing a loss of 75,613.44 yuan to the medical insurance fund [5]. - Case 4: In Shaanxi Province, Peng utilized the medical benefits of deceased individuals to fraudulently acquire medications, resulting in a loss of 60,769.96 yuan [6][7]. - Case 5: In Gansu Province, Heng collaborated with others to create a fraudulent scheme that involved selling medications obtained through the misuse of medical insurance, leading to a loss of 369,772.72 yuan [8]. - Case 6: In Sichuan Province, Qian exploited the insurance of a deceased individual to fraudulently acquire and sell medications, causing a loss of 13,815.90 yuan [9][10]. - Case 7: In Fujian Province, a group of patients conspired to overprescribe medications, resulting in significant losses to the medical insurance fund [11][12]. - Case 8: In Qinghai Province, Bai fraudulently used another person's identity to obtain medical benefits, leading to a total cost of 37,879.4 yuan [13][14]. - Case 9: In Ningxia, an individual named Ou allowed others to use his social security card for fraudulent medical claims, involving a loss of 11,984.66 yuan [15]. - Case 10: In Hunan Province, Li and a pharmacy conspired to forge documents to claim medical insurance funds, resulting in a loss of 35,000 yuan [16]. - Case 11: In Inner Mongolia, Ma was found to have submitted falsified medical records to obtain benefits, leading to a loss of 7,953 yuan [17]. Group 2: Regulatory Response and Public Awareness - The recent cases illustrate the diverse and harmful nature of fraudulent activities against medical insurance, prompting strict legal repercussions including criminal charges, full restitution, and suspension of medical qualifications [18]. - The National Medical Insurance Administration calls for increased legal awareness among insured individuals and urges medical institutions and professionals to adhere to regulatory standards, fostering a cooperative environment for monitoring and reporting fraudulent activities [18].

Core Viewpoint - The article discusses the administrative penalties imposed on Heilongjiang Sipai Pharmacy for fraudulent prescription practices, highlighting the implications for the company and the healthcare industry in China [1][2][4]. Company Summary - Heilongjiang Sipai Pharmacy was found to have sold drugs using 7,869 forged prescriptions, leading to a penalty of 96.95 million yuan for defrauding the medical insurance fund [2][4]. - The pharmacy's operating license was revoked by the Harbin Market Supervision Administration on July 1, 2025, following the investigation [2][4]. - The company is a subsidiary of Sipai Health, which reported a revenue of 4.565 billion yuan in 2024, with a loss of 362 million yuan [4][5]. - Sipai Health's specialty pharmacy business generated 3.975 billion yuan in revenue in 2024, accounting for approximately 87% of its total revenue, but saw a year-on-year decline of 5.1% [4][5]. Industry Summary - The incident reflects broader issues within the pharmaceutical retail sector, particularly concerning the sale of prescription drugs without proper authorization, which undermines the integrity of the healthcare system [7][8]. - The regulatory environment is tightening, with increased scrutiny on pharmacies to prevent fraudulent activities that exploit medical insurance funds [6][7]. - The specialty drug market, which includes high-value medications for critical illnesses, is subject to strict purchasing protocols to prevent abuse, indicating a need for compliance and oversight in the industry [7][8].

Core Viewpoint - The article discusses the administrative penalties imposed on Heilongjiang Sipai Pharmacy for fraudulent activities involving the forgery of prescriptions to illegally obtain medical insurance funds, highlighting the regulatory scrutiny in the pharmaceutical industry and its implications for the company involved [2][3][4]. Group 1: Company Actions and Penalties - Heilongjiang Sipai Pharmacy had its drug operating license revoked by the Harbin Nankai District Market Supervision Administration on July 1, 2025, due to the forgery of prescriptions [3]. - The pharmacy was found to have sold drugs using 7,869 forged prescriptions, with 3,194 of these prescriptions involved in medical insurance settlements, resulting in a fraudulent claim of 19,390,710.95 yuan [4][5]. - The Harbin Medical Security Bureau imposed a fine of 96,953,554.75 yuan on the pharmacy for these violations, marking a significant financial penalty [4][5]. Group 2: Financial Impact on Parent Company - Heilongjiang Sipai Pharmacy is a subsidiary of Sipai Health, which reported a revenue of 4.565 billion yuan in 2024, with a net loss of 362 million yuan [6]. - The specialty pharmacy business, which is crucial for Sipai Health, generated 3.975 billion yuan in revenue in 2024, a decrease of 5.1% year-on-year, accounting for approximately 87% of the company's total revenue [6]. - The company has seen a reduction in the number of specialty pharmacies from 95 at the end of 2023 to 53 by the end of 2024, indicating a significant contraction in its operational footprint [6]. Group 3: Regulatory Environment and Industry Implications - The article highlights the strict regulatory environment surrounding the sale of specialty drugs, which require a rigorous "five determinations" management mechanism to prevent fraud and misuse of medical insurance funds [8]. - The investigation revealed that the pharmacies involved allowed patients to purchase prescription drugs without the necessary prescriptions, undermining the integrity of the healthcare system [9]. - The case reflects broader issues within the pharmaceutical industry regarding compliance with regulations and the potential for significant financial repercussions for companies involved in fraudulent activities [7][8].

以下文章来源于财经三分钟 ，作者杨瑞 财经三分钟 . 4 亿中产财经资讯平台，专注深度财经商业报道。由财经媒体人杨瑞团队执笔，出品《广州租售同 权》、《北京学区房多校划片》、《国家抢占人工智能制高点》等多篇千万级刷屏文章。 作者： 杨瑞 来源： 财经三分钟（ID： qgq1818 ） 江苏无锡虹桥医院，多个部门密谋诈骗医保基金。在医保局介入调查后，一整个诈骗链条终于浮出水 面。 更让人震惊的是，这样恶劣而猖狂的诈骗医保基金事件并不只发生在一家医院身上。 老百姓的"救命钱"时刻都被人惦记着。 不过，正义迟早会到来。那些双手沾上腐败之臭的犯罪分子，终将会被法律制裁。 目前无锡虹桥医院骗保事件的所有相关人员已经全部落网。 ▲图 源：央视新闻 01 猖狂骗保， 无锡虹桥医院销毁证据对抗调查 涉嫌骗保后，无锡虹桥医院并没有配合调查，而是拼尽一切毁灭证据，其中包括了集体串供、篡改病 历、销毁账簿以及修改数据等等。 然而百密一疏，医保局和当地公安局还是找到了蛛丝马迹，最终还原了整个作案链条。 首先，医院内部人士和中介勾结。 随后，中介以一定报酬为诱找人假冒成病人。假病人进入医院后，会被安排住院1-2天，期间医院会 为假病人 ...