警方抓获一个以"中医馆"为噱头专门针对老年群体非法吸收公众存款的犯罪团伙。 免费泡脚和发放鸡蛋，之后各种游说，邀请老年人投资康养基地、疗养服务……这样的套路背后，实际 上是发生在成都的一起特大医保诈骗，以及针对老年群体非法吸收公众存款案件的缩影。 免费泡脚、发鸡蛋引流 3500余名老人中招 它的源头，要从2025年年初成都市公安局金牛区分局接到的一条涉嫌欺诈骗保的线索说起：有群众报 警，金牛区辖区内，有一家"中医养生馆"，平时以提供免费旅游和免费医疗为诱饵，吸纳老年人缴纳会 费。然后，通过下设的医疗服务站、诊所等，虚开药品清单、空开住院记录、空刷国家医保统筹基金等 虚假方式诈骗国家医保统筹基金和国家医疗保险。 截至案发，该犯罪团伙已非法向3500余名老年群众吸收存款共计3600余万元。2025年12月31日，记者通 过采访办案民警和多方走访，对这起横跨医保诈骗与非法吸收公众存款的复合型犯罪网络进行了一番调 查和了解。 免费泡脚、发鸡蛋"引流" 警方揭秘"投资返利"环节 中医馆变成"诈骗流水线" "这些老年人怎么频繁在这里进进出出？有什么猫腻？"一家位于金牛区某地的"中医养生馆"，表面上是 健康管理公司，实际上 ...

本报讯（记者蒋杰 通讯员方芳 许谈青山）明明因交通事故受伤，却在就医时谎称在家摔伤，意图使 部分医疗费用通过医保基金结算。2025年11月，经浙江省象山县检察院提起公诉，法院以诈骗罪分别判 处被告人张某某、陆某发、陆某顺有期徒刑七个月，缓刑一年，各并处罚金3000元。 考虑到陈阿婆伤势严重，陆某顺担心张某某事后反悔，于是选择先报警确定交通事故责任。经认定，小 井负事故全部责任。责任明确后，陆某发父子同意了张某某的请求，在医生询问受伤原因时隐瞒了陈阿 婆被他人撞伤的事实，谎称是摔伤住院，无第三方责任及赔偿。2023年5月至6月，陆某发父子用陈阿婆 的医保卡结算，骗取国家医保统筹基金2.3万余元。 2025年9月9日，象山县医疗保障局发现陆某发父子明知陈阿婆在交通事故中受伤，却仍使用医保报销， 遂向公安机关移送该案线索。同日，公安机关对陆某发、陆某顺涉嫌诈骗案立案侦查。9月22日，陈阿 婆向医保中心退回全部外伤报销款。 案件被移送象山县检察院审查后，办案检察官发现，向医院隐瞒交通事故的建议是张某某提出的，陆某 发和陆某顺则明知交通事故不能用医保结算，仍谎称陈阿婆在家摔伤并进行报销，3人的行为应当认定 为合谋骗取医 ...

Core Points - A pharmaceutical representative from a certain company was sentenced for fraud after altering patient genetic test reports to meet sales targets, leading to misuse of targeted cancer medication and resulting in a loss of 27,540 yuan from the medical insurance fund [1][2] Group 1: Legal Proceedings - The court found that the representative's actions constituted fraud under Article 266 of the Criminal Law of the People's Republic of China, as he aimed to illegally occupy state medical insurance funds [2] - The representative was sentenced to eight months in prison and fined 7,000 yuan, with a requirement to return the illegal gains to the medical insurance fund [2] Group 2: Industry Implications - The case highlights the critical importance of adhering to drug usage guidelines, particularly for targeted cancer therapies, which require strict compliance with indications and genetic mutation conditions to ensure effective treatment [2] - The incident serves as a warning to the industry about the severe consequences of violating ethical standards and regulations, emphasizing that crossing legal boundaries can lead to significant legal repercussions [2]

Core Points - The Sichuan Provincial Medical Insurance Bureau announced the successful investigation of a major medical insurance fraud case involving five medical institutions, including Chengdu Jiuxing Kidney Hospital and Chengdu Gaoxin Bolin Hospital, with a total fraud amount of 48.08 million yuan [1] - The investigation led to the termination of medical insurance agreements with the involved institutions, the detention of 35 individuals, and the approval of arrests for 16 individuals [1][4] - Longsheng Medical, a well-known national dialysis chain, operates over 100 hospitals and centers across 15 provinces, providing services to more than 17,000 dialysis patients [2] Medical Institutions Involved - Chengdu Jiuxing Kidney Hospital and Chengdu Gaoxin Bolin Hospital are part of Longsheng Medical, which has been implicated in fraudulent activities such as selling "return flow drugs" and offering free dialysis [1][2] - Following the fraud investigation, Chengdu Jiuxing Kidney Hospital has reportedly ceased operations, while Chengdu Gaoxin Bolin Hospital has been rebranded as Chengdu Gao Xin South Hospital, which is currently operational [4][5] Regulatory Actions - The National Medical Insurance Administration has issued a notice to address fraudulent practices in the dialysis sector, emphasizing the need for medical institutions to charge based on actual services provided and prohibiting misleading practices such as "free treatment" [3] - The Sichuan Provincial Medical Insurance Bureau has recovered 4.89 million yuan in principal and penalties from the involved institutions and has suspended payments totaling 70.41 million yuan [4]

Core Viewpoint - The company Shenzhou Cell is embroiled in a series of medical insurance fraud cases involving its product, Anjain, which is a recombinant human coagulation factor VIII for hemophilia A patients. Investigations are ongoing, and several patients and sales representatives are implicated in fraudulent activities related to insurance claims [1][4][5]. Group 1: Company Overview - Shenzhou Cell's Anjain is the first domestically approved recombinant human coagulation factor VIII in China, launched in 2021, primarily for controlling and preventing bleeding in hemophilia A patients aged 12 and older [2]. - The company claims to adhere to legal and compliance standards, emphasizing that the actions of individual sales representatives do not reflect the overall operational strategy of the company [4][20]. - Following the launch of Anjain, the price of recombinant factor VIII has decreased by nearly 50% due to national drug procurement policies [4]. Group 2: Fraud Allegations - The allegations involve Shenzhou Cell's sales team collaborating with patients to fraudulently obtain insurance reimbursements by misrepresenting medical conditions, leading to significant financial gains from the insurance fund [5][11]. - A specific case highlighted that a patient fraudulently obtained over 1.19 million yuan in reimbursements, with the company allegedly providing a 4% rebate on the medication costs to patients [5][19]. - The legal framework stipulates that adult hemophilia patients are only eligible for insurance reimbursement when they exhibit bleeding symptoms, making the fraudulent claims particularly egregious [8][11]. Group 3: Market Impact - Anjain has rapidly gained market share, becoming the leading product in its category within three years of its launch, attributed to its lower price compared to foreign competitors [16]. - The company has established a charitable assistance program that allows patients to receive treatment at no cost, effectively covering the out-of-pocket expenses through partnerships with charitable organizations [17][20]. - The sales strategy has reportedly enabled patients to receive not only free treatment but also cash rebates, creating a controversial but effective market penetration model [18][19]. Group 4: Legal and Compliance Issues - Legal experts indicate that the sales representatives may face significant legal consequences, as their actions reflect a clear understanding of the fraudulent nature of their activities, despite claims of merely following company directives [15][21]. - The company has publicly stated its commitment to compliance and has denied any involvement in fraudulent activities, asserting that any misconduct by individual employees does not represent the company's practices [4][20].

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].

Group 1 - The article highlights the serious issue of healthcare fraud in Shanghai, particularly involving illegal resale of medications acquired through the medical insurance system [1][2] - In 2025, Shanghai authorities dismantled seven healthcare fraud rings, arresting over 130 suspects and involving more than 14 million yuan in fraudulent activities [2] - A specific case involved a network where medications were purchased at significantly reduced prices (as low as 10 yuan) from insured individuals and then resold at higher prices, creating a comprehensive illegal supply chain [3][4] Group 2 - The fraud operations often targeted elderly individuals, with perpetrators posing as second-hand goods collectors to encourage them to sell their prescribed medications [6][8] - Two private Chinese medicine clinics were found to have engaged in fraudulent practices, including excessive billing for services not rendered and manipulation of medication records [10][11] - A significant fraud ring led by a figure named Yan was uncovered, with over 50,000 fraudulent claims amounting to more than 12 million yuan in total [12]

Core Viewpoint - The article highlights the serious issue of healthcare fraud in Shanghai, particularly focusing on two private traditional Chinese medicine clinics that have defrauded the medical insurance system of over 12 million yuan through false diagnoses and treatments [3][4]. Group 1: Fraudulent Activities - A police investigation revealed that the Shanghai Yiyang Traditional Chinese Medicine Hospital had suspicious billing practices, with many patients showing frequent visits without actual treatment, indicating potential fraudulent activities [3][4]. - The investigation uncovered that staff members at the clinics were involved in swapping expensive medicinal herbs for cheaper alternatives, profiting from the difference while defrauding the insurance system [4]. Group 2: Criminal Organization Structure - The criminal organization involved clinic management and staff who coerced employees into conducting false diagnoses, while also collaborating with "scalpers" to bring in insured patients for fraudulent billing [4]. - The operation included a network of individuals who collected and resold medications illegally, creating a comprehensive illicit supply chain [8]. Group 3: Law Enforcement Actions - The police successfully dismantled a fraud ring, arresting 12 suspects and seizing over 1.2 million yuan worth of drugs [7][11]. - New regulations were introduced requiring pharmacies to scan drug traceability codes during sales to combat fraud, with penalties for non-compliance [12][13].