Workflow
医保药品
icon
Search documents
倒卖医保药品套取现金获刑 国家医保局公布7起个人欺诈骗保案例
Yang Shi Wang· 2025-09-11 06:40
Core Viewpoint - The National Medical Insurance Administration is intensifying efforts to combat fraudulent activities related to medical insurance funds, emphasizing the importance of safeguarding public health resources and ensuring the sustainability of the medical insurance system [1][8]. Group 1: Fraud Cases - Case 1: In Shenzhen, an individual named Li exploited others' medical insurance accounts to sell drugs illegally, defrauding the medical insurance fund of 93,013.68 yuan, with total illegal transactions amounting to 169,025.00 yuan [1]. - Case 2: In Beijing, a couple named Yu and Wang were caught selling medical drugs at lower prices, acquiring drugs worth over 110,000 yuan, and were sentenced to 1 year and 2 months in prison [2]. - Case 3: In Hubei, two individuals, Qiu and Ke, misused their outpatient chronic disease benefits to sell drugs, resulting in a total fraud amount of 408,25.78 yuan [3]. - Case 4: In Shanghai, a retiree named Hu was found selling drugs purchased through medical insurance, leading to a recovery of 5,223.31 yuan in funds [4]. - Case 5: In Xinjiang, a retiree named Tan submitted fraudulent medical bills totaling 426,218.45 yuan over several years, resulting in a prison sentence of 3 years [5]. - Case 6: In Jilin, an individual named Gao fraudulently claimed reimbursement for medical expenses already covered by a third party, amounting to 27,394.69 yuan [6]. - Case 7: In Tianjin, Zhang was found to have used another person's medical insurance card to claim medical expenses of 11,284.99 yuan [7]. Group 2: Regulatory Actions - The National Medical Insurance Administration, in collaboration with various governmental departments, is conducting a nationwide crackdown on fraudulent activities, highlighting the importance of maintaining a high-pressure regulatory environment [1][8]. - The administration is utilizing big data and technology to monitor and identify suspicious activities related to medical insurance claims [2][4][6]. - There is a strong emphasis on educating the public about the legal implications of fraud and the importance of adhering to medical insurance regulations [8].
消费贷贴息“国补”出炉,沪指两次突破3700点丨一周热点回顾
Di Yi Cai Jing· 2025-08-16 02:48
Group 1: Consumer Loan Subsidy Policy - The central government has introduced a subsidy policy for personal consumer loans and service industry loans, referred to as "national subsidy" in the consumer loan sector [2][3] - The subsidy rate is set at 1 percentage point for both personal consumer loans and service industry loans, aimed at reducing credit costs for residents and businesses [2][3] - The policy targets consumption in key areas such as home appliances, automobiles, education, and healthcare, with specific conditions for loans to service industry entities [2][3] Group 2: Economic Indicators - In July, the industrial added value increased by 5.7% year-on-year, while retail sales of consumer goods grew by 3.7%, both showing a decline compared to June [4] - Fixed asset investment from January to July rose by 1.6%, indicating a slowdown in growth compared to the first half of the year [4] - The National Bureau of Statistics highlighted external challenges such as trade protectionism and extreme weather affecting economic performance [4] Group 3: Social Financing and Monetary Supply - As of the end of July, the total social financing scale reached 431.26 trillion yuan, with a year-on-year growth of 9% [5] - The increase in bond financing has significantly contributed to the growth of social financing, with government bond net financing up by 4.88 trillion yuan year-on-year [5] - The M2 money supply grew by 8.8% year-on-year, while M1 increased by 5.6%, indicating improved liquidity and efficiency in the financial system [5][6] Group 4: Stock Market Performance - The Shanghai Composite Index broke through the 3700-point mark, reaching a high of 3704.77 points, marking a significant recovery in the A-share market [7] - The number of new stock accounts opened in July surged by 71% year-on-year, reflecting increased investor enthusiasm [7] - Analysts suggest that the upward momentum in the stock market is supported by clear policy backing and the influx of new capital [7] Group 5: Trade Relations - The U.S. and China have agreed to suspend the implementation of 24% tariffs for 90 days, while retaining 10% tariffs on certain goods [8] - This agreement follows a series of trade talks aimed at reducing tensions and enhancing cooperation between the two nations [8] - The ongoing discussions indicate a willingness to engage in dialogue to resolve trade issues, although challenges remain [8] Group 6: Healthcare Policy - The National Healthcare Security Administration has published a list of drugs that passed the preliminary review for inclusion in the national medical insurance and commercial insurance innovation drug directories [9] - A total of 534 drugs were approved for the basic medical insurance directory, while 121 drugs were approved for the commercial insurance innovation directory [9][10] - The introduction of the commercial insurance innovation drug directory aims to support high-value innovative drugs and facilitate their market entry [10] Group 7: Taxation Policy - The Ministry of Finance and the State Taxation Administration have released a draft for public consultation regarding the implementation of the Value-Added Tax Law, set to take effect on January 1, 2026 [11][12] - The draft aims to clarify regulations and enhance the operability of the tax system, although expectations for loan interest to be tax-deductible were not met [11][12] - The implementation of the VAT law is seen as a crucial step in establishing a comprehensive legal framework for taxation in China [12]
534个药品通过2025年国家医保药品目录形式审查
Xin Hua She· 2025-08-12 08:05
Group 1 - The National Medical Insurance Administration (NMIA) announced the preliminary results of the 2025 National Medical Insurance Drug List review, with 534 drugs passing the formal review, indicating an increase in the number of drug applications compared to 2024 [1] - The adjustment process for the medical insurance drug list includes several stages: enterprise application, formal review, expert evaluation, negotiation and bidding, and price consultation [1] - A new category for commercial insurance innovative drugs has been added this year, with 141 generic drug names submitted for review, of which 121 passed the formal review [1] Group 2 - Some drugs applied for both the basic medical insurance list and the commercial insurance innovative drug list, leading to potential discrepancies in the review results due to differing application criteria [1] - Expensive drugs that exceed the basic medical insurance coverage may pass the preliminary formal review, but their final inclusion in the basic medical insurance list depends on strict evaluation procedures, including successful negotiations for exclusive drugs and competitive bidding for non-exclusive drugs [1] - The public consultation period for the announced results will end on August 18, during which the NMIA will review feedback and finalize the list of drugs that passed the formal review [2]
严查回流药!国家医保局公布十起典型案例
Xin Hua She· 2025-07-26 14:22
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]
“十四五”医保成绩单发布,医保基金累计支出超12万亿元
Di Yi Cai Jing· 2025-07-24 05:01
Group 1: Healthcare Insurance and Coverage - The national basic medical insurance coverage rate remains stable at around 95%, with an expected 1.327 billion people insured by 2024, representing a 1.6 times increase from 2020 [1][3] - Cumulative expenditure of the medical insurance fund during the 14th Five-Year Plan period reached 12.13 trillion yuan, with an annual growth rate of 9.1% [1] - The multi-tiered medical security system is being established, including basic medical insurance, serious illness insurance, and medical assistance [3] Group 2: Long-term Care Insurance - As of June 2025, 253 million people are expected to participate in maternity insurance, with cumulative expenditures of 438.3 billion yuan [3][4] - The long-term care insurance system aims to alleviate the financial burden of daily care for the elderly and disabled individuals [3][4] Group 3: Medical Fund Management and Regulation - The National Medical Insurance Administration is enhancing the regulation of medical insurance funds to combat fraud and misuse, with 335,000 medical institutions inspected in the first half of the year, recovering 16.13 billion yuan [7] - The transition from a "post-payment" to a "pre-payment" system is being implemented, promoting efficiency in medical institutions and reducing patient out-of-pocket expenses by approximately 5% year-on-year [6] Group 4: Drug Price Governance - The 11th batch of centralized drug procurement has been initiated, emphasizing principles such as maintaining clinical stability and ensuring quality [9] - Since 2018, 10 batches of drug procurement have been conducted at the national level, covering 435 types of drugs, which has helped lower drug costs and improve accessibility [9]
国家发改委:402种药品新增进入国家医保药品目录
news flash· 2025-07-09 02:58
Core Points - The National Development and Reform Commission's Deputy Director Zhou Haibing announced that since the beginning of the 14th Five-Year Plan, 402 new drugs have been added to the national medical insurance drug list [1] - The convenience of cross-provincial medical insurance settlement has improved [1] - The construction of a high-quality service system for the elderly and children is accelerating, with the proportion of nursing care beds for the elderly increasing to 64.6% [1]
我国7月1日起全面实施医保药品扫码结算
Bei Jing Shang Bao· 2025-06-18 00:52
Group 1 - The National Healthcare Security Administration (NHSA) has made significant progress in addressing issues related to the management of medical insurance funds, particularly in combating illegal activities such as the resale of "returned drugs" [1] - "Returned drugs" refer to pharmaceuticals that have exited the legitimate distribution channels and re-entered the market, often through illegal means, posing risks to public health and safety [1] - The NHSA has launched a drug traceability information query function on its platform, allowing pharmacies to identify "returned drugs" through scanning, thereby ensuring the legality of drug sources [1][2] Group 2 - As of now, the NHSA has collected a total of 39.885 billion drug traceability codes to assist in combating the "returned drug" issue [2] - The NHSA plans to enhance the regulatory application of drug traceability codes, focusing on building a big data regulatory model to combat illegal drug trading and other violations [2] - The NHSA has initiated a special action to combat the production and sale of counterfeit and inferior drugs, with the first phase of verification tasks completed and several cases of "returned drugs" being addressed [2]
广西实行定点零售药店“无码不结”
Guang Xi Ri Bao· 2025-05-08 01:51
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]
【省医保局】陕西全面实行定点零售药店医保药品“依码支付”
Shan Xi Ri Bao· 2025-04-27 22:45
Core Viewpoint - Shaanxi province has implemented new regulations requiring all designated retail pharmacies to collect and upload drug traceability codes when selling medical insurance drugs, with non-compliance resulting in non-reimbursement by medical insurance [1][2] Group 1: Drug Traceability System - The drug traceability code serves as an "electronic ID" for pharmaceuticals, ensuring each drug has a unique sales record to prevent counterfeit or swapped drugs [1] - The traceability system currently covers 12 coordinated areas in Shaanxi, connecting nearly 23,000 designated medical institutions and over 15,000 retail pharmacies [1] Group 2: Payment and Compliance - The "code-based payment" system allows medical insurance departments to settle payments based on the traceability codes, enhancing both drug safety and the security of medical insurance funds [1] - Medical insurance will not reimburse costs for drugs that should have been traced but were not, although this does not affect the normal process of medical treatment and reimbursement for insured individuals [1] Group 3: Public Awareness and Reporting - The provincial medical insurance bureau encourages insured individuals to actively request pharmacies to scan codes and verify traceability information when purchasing drugs [2] - Consumers are advised to report any discrepancies found during the verification process, such as previously sold drugs, to the medical insurance department [2]