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Recently, when screening data from the big data center of the National Health Insurance Administration, it was found that in a pharmacy in Harbin City, Heilongjiang Province, there were 96 insured people who purchased drugs from the pharmacy for a particularly huge amount, and the amount of drugs purchased by the insured person with the largest amount in two years even exceeded one million yuan. From August 20th to 26th, CCTV reporters from the main station followed the special flight inspection team sent by the National Health Insurance Bureau to Harbin City, Heilongjiang Province to investigate.
Take the drug for 3 consecutive years for short-term use
Millions of drugs are involved
Follow the reporter of the inspection team to the patient's home screened by big data. According to the reporter's inquiry into the medical insurance drug catalog, the drug named avatrombopag maleate tablets, referred to as avatrombopag, belongs to the national class B reimbursement drug, and is an outpatient special drug suitable for adult patients with chronic liver disease-related thrombocytopenia who undergoes elective diagnostic surgery or surgery. It is usually taken for a short period of time prior to interventional therapy.
According to the calculation of 3 tablets a day and normal consumption for 5 days, this patient only needs one box in total, which is enough for the preoperative amount of medicine required for interventional surgery. According to the patient, he told the investigators that he had been taking the drug for a long time and had three tablets a day. According to statistics, within two years, the patient purchased about 160 boxes of avatrombopag with a total of 2,400 tablets with a unit price of 7,140 yuan, an amount of more than one million yuan, and took it for a total of 800 days, far exceeding the reasonable clinical dosage.
According to experts, after taking avatrombopag for interventional surgery, whether it is necessary to continue to use drugs for treatment, as well as the duration and dosage of use, need to be prescribed by doctors after diagnosis according to the condition at regular intervals. So how did such a super-clinical dosage of drugs come out? According to the patient's account, his son went to the pharmacy to buy medicine and pick up medicine for three years after his illness.
Prescription drugs should be prescribed
The patient had questions
Buy millions of dollars in prescription drugs without a prescription. Is it really what this patient and his son say? The reporter followed the flight inspection team to four pharmacies, including Harbin Jianbaijia Pharmaceutical Chain Haping Road Store, Sipai Pharmacy, Baofeng Pharmacy Shenye Store, and Shanghai Pharmaceutical Science Park Pharmacy to investigate.
During the investigation, the reporter noticed a strange phenomenon. At the Harbin Spire Pharmacy in Heilongjiang, patients who came to buy prescription drugs had questions about the pharmacy saying that they could not buy prescription drugs without a prescription.
Prescription drugs cannot be bought without a prescription, which is the basic policy that pharmacies should implement. However, when he heard the pharmacy staff reply that he could not buy prescription drugs without a prescription, the patient looked puzzled. This anomaly has alarmed the investigation team and journalists.
Before entering the survey, patients are free to purchase high-cost prescription drugs
In conversations with patients, the reporter found that patients who had previously purchased drugs here did not need to provide prescriptions to buy these high-priced prescription drugs. After the investigation team and reporters were stationed to carry out the investigation, the pharmacy temporarily asked the patient to provide a prescription on the same day, and it must be a prescription on the same day.
The handwritten prescription for "special medicine" was revealed
The "black hole" of the loss of medical insurance funds
Drugs such as avatrombopag sold in pharmacies such as Sipai Pharmacy investigated by the reporter are all special drugs for the treatment of special diseases, referred to as "special drugs". According to the regulations, when "special drugs" are sold, the corresponding prescription must be retained. The inspection team immediately launched an investigation into four pharmacies, including Jianbaijia Pharmaceutical Chain Haping Road Store, Sipai Pharmacy, Baofeng Pharmacy Shenye Store, and Shanghai Pharmaceutical Science Park Pharmacy, and asked the pharmacies to provide relevant bills retained by patients for recent drug purchases.
When the four pharmacies in Harbin, Heilongjiang Province, produced the relevant qualification materials and prescriptions issued in recent years, the inspection team found that almost all the prescriptions provided by the pharmacies were handwritten.
These handwritten prescriptions, the amount of drugs issued in a single sheet is as little as nearly 1,000 yuan, as much as 10,000 yuan or 20,000 yuan, such a large amount of special drug prescriptions, should be more strictly managed, how can it be handwritten? The inspection team noticed that many of these handwritten prescriptions were marked with medical institutions such as the Affiliated Cancer Hospital of Harbin Medical University. So are these prescriptions issued from these hospitals?
Special flight inspection investigators of the National Health Insurance Administration: This prescription is all handwritten and stamped, so we don't have the ability to distinguish between the serious and the fake, so please ask this expert from the Harbin Medical University Cancer Hospital to help distinguish the serious from the fake.
Staff of the Affiliated Cancer Hospital of Harbin Medical University: Our hospital does not have this kind of paper handwriting now, and this kind of thing has long been canceled.
At the scene of the investigation, the entire handwritten prescription was found with different stamps
However, the findings that followed were even more shocking. When the prescriptions provided by the pharmacy were counted, there were still several prescriptions that had not yet been torn up, and the whole book was already full of the signatures of the prescribing drugs and the different doctors. And there are tens of thousands of such handwritten prescriptions.
Special flight inspection investigators of the National Health Insurance Bureau: These two books are relatively neat, the whole book is not torn, the content is different drugs, and the doctors are also different doctors. The doctor's seal has been stamped, and this should be preset, because this doctor is a different department, corresponding to a different targeted drug.
Staff of the Affiliated Cancer Hospital of Harbin Medical University: The fonts are all from one person's font, but the chapter is not from the same doctor, so I think it is more likely to be fake.
It is understood that special drugs for the treatment of special diseases, such as avatrombopag, referred to as "special drugs", generally have high clinical value, urgent needs of patients, and low substitution. In order to reduce the burden of these seriously ill patients, the medical insurance department will also adjust the medical insurance reimbursement policy for the drugs included in the "special drug" sequence according to the actual situation. "Special drugs" in many regions can enjoy policies such as no minimum payment line, reimbursement ratio of more than 80%, and increased reimbursement ceiling.
Correspondingly, the process of purchasing "special drugs" is very strict, and it is necessary to go through the "five determinations" management mechanism of designated patients, designated medical institutions, designated responsible physicians, prescribed prescriptions, and designated retail pharmacies before they can be sold and purchased, so as to prevent criminals from taking advantage of preferential policies to obtain medical insurance funds.
A breakthrough was made in the investigation
The pharmacy admits that the prescription is forgery
The reporter followed the special flight inspection team of the National Health Insurance Bureau to visit and collect a large number of evidence, especially for the authenticity of the prescription to obtain information, and the investigation finally made a breakthrough.
After more than three hours of questioning, the person in charge of the Shenye store of Harbin Baofeng Pharmacy finally admitted that a large number of handwritten "special medicine" prescriptions were not issued from the hospital, but were provided by a medical representative of the medicine.
In the process of communicating with the licensed pharmacist of another pharmacy, Jianbaijia Haping Road Pharmacy, it was also confirmed that the handwritten "special medicine" prescription was purchased from the Internet and then processed.
According to the investigation, the four pharmacies in Harbin, Heilongjiang Province, have tens of thousands of handwritten fake prescriptions, with a total amount of more than 100 million yuan.
At present, the National Health Insurance Bureau has handed over some of the problems found in the special unannounced inspection of pharmacies involving "special drugs" to the local public security.
(Source: CCTV News)