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骗取医保基金1939万元!思派健康子公司被处罚9695万元
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 - The pharmacy's operating license was revoked by the Harbin Market Supervision Administration on July 1, 2025, following the investigation [2][4].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].
骗取医保基金1939万元 思派健康子公司被处罚9695万元
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].
186亿医保被骗光,国家医保局出手了!
商业洞察· 2024-10-11 09:09
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 ...