"Reflux drugs" are harmful, and the National Health Insurance Administration issued a reminder

April 26, 2024

Source: National Health Insurance Administration

In recent years, with the continuous improvement of the level of medical insurance reimbursement, the gradual expansion of the scope of drugs in the medical insurance catalog, especially the steady progress of the reform of employee medical insurance outpatient mutual aid security, it is more convenient for the people to buy drugs and drugs, and hospitals, pharmacies, clinics, and even online can purchase drugs and be reimbursed by medical insurance. However, while the policy of benefiting the people brings benefits and convenience to the whole people, it also makes some criminals think crookedly, and many drug dealers induce the insured to participate in drug trading through "high-price recycling". This kind of disguised recovery of the drugs purchased by the insured after enjoying the reimbursement of medical insurance, and reselling them in a different guise, is the "reflux drug" of medical insurance.

Is it possible to deal with the medicine in your hand in this way?

In some places, the medical insurance policy is good, and the reimbursement ratio for some special diseases is high, and patients can prescribe drugs with a total price of more than 100 yuan at their own expense of 10 yuan, even if they are sold at half price of 50 yuan, and what else can be earned?

Some patients have a mild illness, but describe the serious condition to the doctor, and ask for the medicine to be prescribed according to the upper dosage, eat one and sell three servings, both cure the disease and make money?

Some people are cured and prescribed too many medicines, idle and wasted, and it is a pity to throw them away, why don't they all be sold and make a little money to subsidize the family?

There are also some people whose medicine at home is about to expire, and someone happens to collect it at a high price, so they simply sell it, anyway, they don't lose money?

Friends who hold such ideas may become accomplices of drug dealers because of greed for small profits, causing irreparable losses to themselves and others.

What are the dangers of "reflux drugs"?

First, counterfeit drugs are harmful. Some drug dealers sell real drugs to small clinics with scattered medicines, and then fill the real medicine boxes with fake drugs and sell them to pharmacies, so that if patients accidentally take them, not only will the treatment effect be affected, but also more likely to endanger their lives.

The second is that expired medicine misleads people. Because the expiration date of drugs is not directly printed on the tablets, many drug dealers remove expired or expired drugs from their original packaging and put them into new boxes. Patients can only see the date on the new medicine box, and do not know that they are taking expired medicines, which can delay the disease at least and lose their lives.

The third is that the wrong medicine hurts people. In the process of dismantling and reassembling "reflux drugs", some drug dealers often have confusion about the dosage specifications and drug types. Children who take adult drugs can be life-threatening, patients who need to promote blood circulation can die directly after taking coagulation drugs, and some special drugs for mental anesthesia and analgesia are even resold as drugs to young children who pursue novelty...... Huang from Longyan City, Fujian Province, became addicted to drugs but had no income, and embarked on the road of "selling and smoking" in order to take drugs. Huang repeatedly sold narcotic and analgesic drugs to school students and young people in society for huge profits by mailing, direct delivery, and direct peddling at his rented residence, and was later arrested by the public security organs.

Fourth, deceive the insurance pit people. Obtaining drugs through over-dispensing, repeated dispensing, etc., and then reselling them to drug dealers is a form of fraud and insurance fraud. In 2020, the Medical Insurance Bureau of Jinhua City, Zhejiang Province, through big data analysis, found that the medical insurance data of the hemophilia patient Hu was abnormal, and after in-depth investigation, it was found that Hu held multiple people's medical insurance codes and falsely prescribed hemophilia treatment drugs in many hospitals, and then published drug advertisements in the national hemophilia group, and sold the drugs at prices ranging from 1% to 2% for profit. Hu was eventually sentenced to 10 years and six months in prison, and his wife, knowing that his actions were illegal, still assisted him in prescribing and sending medicine, and could not escape legal punishment.

The existence of "reflux drugs" has made doctors afraid to prescribe a large number of drugs, the packaging volume of drugs is getting smaller and smaller, and the market order of normal purchase and sale has been seriously disrupted. The medical insurance fund that should be used to save lives has been continuously eaten by a small number of lawbreakers, and through the "black hands" of drug dealers, "good medicine" may become "poison", and it will be difficult to ensure the safety of drug use by the broad masses of people, and the whole society will pay a huge price because of "reflux medicine".

What are the consequences of participating in the "reflux drug" trade?

The direct sale and indirect auxiliary sales of "reflux drugs" by the insured are all fraudulent insurance fraud.

According to Article 41 of the Regulations on the Supervision and Administration of the Use of Medical Security Funds, if an individual takes advantage of the opportunity to enjoy medical security benefits to resell drugs, accept the return of cash, goods or obtain other illegal benefits for the purpose of defrauding the medical security fund, and causes losses to the medical insurance fund, the online settlement of medical expenses shall be suspended for 3 months to 12 months, and a fine of not less than 2 times but not more than 5 times the amount obtained by fraud shall be imposed. If the amount involved is large and the circumstances are serious, it will also constitute the crime of fraud.

Against drug dealers, national ministries and commissions have also struck hard. In February 2024, the Supreme People's Court, the Supreme People's Procuratorate, and the Ministry of Public Security jointly issued the Guiding Opinions on Several Issues Concerning the Handling of Criminal Cases of Medical Insurance Fraud, which clearly states that "those who illegally purchase or sell drugs that they know are purchased through medical insurance fraud shall be convicted and punished for the crime of covering up or concealing criminal proceeds in accordance with the provisions of Article 312 of the Criminal Law and relevant judicial interpretations; Sales, in accordance with the provisions of Criminal Law article 266, are to be convicted and punished as the crime of fraud. At the recent press conference jointly held by the "two supreme courts and one department", a typical case of cracking down on the crime of "reflux drugs" insurance fraud was exposed. In this case, Ma Moumou, a drug dealer, repeatedly used the medical insurance certificates of 11 people, including Zhao Moumou, to falsely seek medical treatment and purchase drugs in a number of hospitals in Beijing, and sold some of the drugs for profit, and was finally sentenced to eight years and three months in prison.

In April 2024, six departments, including the National Health Insurance Administration, the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, and the National Health Commission, jointly deployed the special rectification work on violations of laws and regulations in the medical insurance fund. The medical insurance department will strengthen the screening and analysis of relevant suspicious issues, and lock the clues of the problem in a timely manner through the intelligent monitoring of medical insurance big data to achieve precise strikes.

Cutting off the "reflux drug" is everyone's responsibility!

Medicines are not ordinary commodities, and for your health and the health of others, please do not sell drugs to drug sellers.

In life, we should also be vigilant, do not buy drugs from unknown sources and damaged packaging, if you find similar fraud and insurance fraud, please call the national bureau to combat fraud and insurance fraud in time 010-89061396, 010-89061397, or report to the local medical insurance department in time. The medical insurance department will give a reward of up to 200,000 yuan depending on the report.

Let each of us take action to cut off the chain of illegal interests of "reflux drugs" and jointly maintain a safe, healthy and harmonious social environment.

Editor in charge: Ren Quanhui

Forward: Yang Hua

Review: Hao Lin