Medical insurance funds are the people's medical treatment money and life-saving money, but they are targeted by some unscrupulous people, who do not hesitate to falsify in order to obtain medical insurance funds.
The result of defying the law is to be ruined and discredited, and all kinds of "social death".
Defrauded medical insurance funds, and the East Window incident
Recently, Wuxi Hongqiao Hospital was suspected of defrauding medical insurance.
According to CCTV Finance, Yicai and other media reports, doctors in the radiology department of the hospital reported that patients in the hospital who had not undergone imaging examinations at all had "judgments based on images" in their medical records.
To put it bluntly, someone in Wuxi Hongqiao Hospital is suspected of falsifying medical records by tampering with CT, MRI image records and other means to obtain medical insurance funds.
The follow-up news is that Wuxi Hongqiao Hospital has been disqualified from medical insurance designation, has been criminally filed, the president and other personnel involved in the case have been taken criminal compulsory measures in accordance with the law, and the hospital has been suspended.
The major shareholder behind Wuxi Hongqiao Hospital is Shanghai Media Hospital Investment Group Co., Ltd., with a 40% stake.
The shareholders of Medea Group are Wang Weimin and Hu Yuzhi, who hold 80% and 20% of the shares respectively.
Wang Weimin is the chairman and president of Medea, and Hu Yuzhi is the president of Wuxi Hongqiao Hospital.
Medea Group has invested in many hospitals, mainly in Shenzhen, Hangzhou, Shanghai, Wenzhou, Wuxi, Kunshan and other economically developed cities.
Specifically, there are Shenzhen Ganglong Hospital, Shenzhen Jianguo Urology Hospital, Hangzhou Tianmushan Hospital, Hangzhou Jianguo Women's Hospital, Shanghai Minhang Hongqiao Hospital, Shanghai Jianqiao Hospital, Wenzhou Jianguo Hospital, Wuxi Hongqiao Hospital, and Kunshan Hongqiao Hospital.
Wuxi Hongqiao Hospital, where the accident occurred this time, is a private second-class hospital, and when it comes to private hospitals, many people will think of the "Putian Department".
In fact, Medea Group was previously controlled by the Chen family, one of the Putian families, but later the Chen family withdrew, and Wang Weimin took over Medea Group in 2020.
Before the accident at Wuxi Hongqiao Hospital, in August, Kunshan Hongqiao Hospital was filed by the local health commission for online rumors that patients were allowed to spend at least 7,000 yuan.
The hospitals that save lives and help the injured also engage in minimum consumption, which is really ruinous.
Two listed companies exposed the problem of medical insurance funds
In addition to Hongqiao Hospital, which has Putian genes, is there any fraud in listed companies to obtain medical insurance funds, or illegal use of medical insurance funds?
There really is, and there is more than one.
Sinocare Biologics, a GEM company mainly engaged in blood glucose detectors, blood lipid detectors and other products, and its wholly-owned subsidiary, Beijing Sinocare Jianheng Diabetes Hospital, have been terminated by the Beijing Medical Insurance Affairs Management Center since December 29, 2023 due to problems such as defrauding the medical insurance fund by fictitious medical service projects, and the illegal fees will be recovered.
After investigation, from July 30, 2021 to October 20, 2022, Sinocare Jianheng Hospital defrauded the medical insurance fund of a total of 93,495.81 yuan.
In terms of stock price performance, Sinocare Biotech has fallen 16% since the beginning of this year, and the company's actual controller Li Shaobo has handled a new equity pledge since May, and he and his concerted actors have pledged a total of 75.55 million shares, accounting for 52.67% of the shares held.
Previously, Li Shaobo's concerted actors were his partner Che Hongli, who held as much as 90% of the company's shares before going public. In 2016 and 2017, Che Hongli made a large number of reductions and cashed out hundreds of millions of yuan at every turn.
At present, Che Hongli is still the second largest shareholder of Sinocare Biotech, with a shareholding ratio of 21.94%.
Veterans like Che Hongli have greatly reduced their holdings, and the heavy public funds are about to be withdrawn. For example, Ruiyuan Equilibrium Value and Huabao CSI have reduced their holdings in the past few months.
Sinocare Biotech does its own medical device business and also controls the diabetes hospital, which can be said to be easy to produce "its own factory products are sold in its own hospital".
In fact, medical device companies, especially large medical device companies, have always been the hardest hit areas of medical corruption. A piece of equipment can easily be millions or tens of millions, and its rebate amount is not comparable to ordinary drugs.
In addition to hospitals and medical device companies, the pharmaceutical retail industry is direct-to-consumer, and there are many problems inside.
Yixintang, a well-known pharmacy interlocking listed company, has caused losses to the medical insurance fund due to problems such as collusion of drugs, over-prescribing of drugs, and medical insurance settlement on behalf of stores that suspend medical insurance settlement. On May 24 this year, the company became the first listed pharmacy company to be publicly interviewed by the National Health Insurance Administration.
The National Health Insurance Administration requires Yixintang to deeply understand the extreme importance of maintaining the safety of the medical insurance fund, effectively enhance the sense of urgency and responsibility for the legal and compliant use of the medical insurance fund, and fully implement the laws, regulations and various provisions.
The National Health Insurance Bureau also conveyed to Yixintang the requirements of strengthening ideological understanding, improving the internal control system, carrying out self-examination and self-correction, and taking the initiative to return the medical insurance funds used in violation of laws and regulations.
On August 16, the information released by the National Health Insurance Administration showed that Yixintang had returned more than 1,070 yuan of medical insurance funds involved in violations from May 1, 2021 to May 30, 2024.
The stock price plummeted, and the self-media took the blame?
The illegal use of medical insurance funds by pharmacies is a very serious matter, and for pharmacies, if they are disqualified from medical insurance designated pharmacies because of this kind of thing, it will be a devastating loss.
Perhaps it is this matter that has made the capital market have a serious negative psychological expectation of Yixintang, since Yixintang was interviewed by the National Health Insurance Bureau, its stock price has shown a unilateral downward trend, from around 22 yuan in late May to the lowest 10.84 yuan on September 18, and the stock price has been cut in half in 4 months!
However, Yixintang is also trying to downplay the impact of this matter. The company's leaders said at the 2024 interim report performance exchange meeting on September 1 that the self-inspection and self-correction of medical insurance has no impact on the company's business, and the company's business has returned to normal.
The company's leaders also said that after the interview began, the biggest disturbance was the excessive interpretation of the self-media, which led to a change in consumer perception.
This means that the pot of the plummeting stock price should be carried by the media?
Could it be that the self-media let Yixintang settle medical insurance funds in violation of regulations?
Here to popularize science, the use of medical insurance funds by designated retail pharmacies in violation of laws and regulations mainly includes the following situations:
First, falsely prescribing drugs and swiping the medical insurance code to defraud the medical insurance fund.
Second, the exchange of drugs is mainly the exchange of non-drugs for medical insurance drugs, and the exchange of low-cost drugs for high-priced drugs.
Third, over-prescribing drugs, selling drugs that they don't need to the insured, or over-prescribing expensive drugs and making medical insurance settlements.
Fourth, to other pharmacies, especially non-medical insurance designated retail pharmacies, for medical insurance settlement.
As the state's supervision and management of the medical insurance fund becomes more complete and meticulous, there may be some listed companies that will be exposed later.
This kind of arbitrage of medical insurance funds is essentially moving everyone's life-saving money, and we must not only condemn the relevant companies, but also stay away from the relevant stocks.