Dajiang Network / Dajiang News Client News Wan Si, reporter Huang Xiangsheng reported: On December 14, the reporter secretly visited and found that many stores of Changsheng Pharmacy in Nanchang City had medical insurance card brushing health care products, and the settlement slip concealed cat greasy and other violations. On December 15, Dajiang Network published an article titled "Reporters Named and Punished for Fraudulently Defrauding Bao Changsheng Pharmacy and Found a Stack of Problems", which aroused social concern and also attracted the attention of the Nanchang Municipal Medical Insurance Bureau. On December 17, the Municipal Medical Insurance Bureau replied to Dajiang Network on this matter: the West Lake District Medical Insurance Business Administration has terminated the medical insurance service agreement with the Fenglin Avenue store, the Xingguo Road store, and the Haili Planning Road store, and the county (district) medical security administrative department of the county (district) involved in the collusion of projects to declare medical insurance settlement will file a case.
3 stores terminated their medical insurance service agreements
Investigation: The statement hides that the cat is sold first and returned immediately
Maplewood Avenue store: Flatten the account And it is difficult to find it when inspecting
On the evening of December 14, consumer Ms. Zhang purchased two bottles of soy phospholipid E softgels and a box of snow skin sheep oil antifreeze, and checked out with a medical insurance card. The reporter saw that the shopping receipt clearly read: Non-drug. The stub on the health insurance card shows: Medicare Consumption. After that, the reporter asked to check the details, and found that the charging item column of the other half of the settlement documents in the clerk's hand was "converted" into a clear yellow pill of the same price.
On the afternoon of December 16, the reporter followed the staff of the Fund Supervision Section of the Municipal Medical Insurance Bureau to the Fenglin Avenue store of changsheng pharmacy that was exposed, checked the invoicing and inventory accounts of the pharmacy, and checked whether there was any collusion of drugs and goods. The reporter saw through the store's cashier system that from 7:34 p.m. to 9:02 p.m. on December 14, within two hours, the same goods were sold first and then returned. This product is the Blind Yellow Pill. The reporter saw from the system that the "message" column also indicated the authorized return person, and the actual amount column also changed from "146 yuan" to "-146 yuan". The staff of the Fund Supervision Section analyzed that it was likely to be done for the purpose of closing accounts.
Xingguo Road store: no delivery record but sales record?
On December 14, the reporter secretly visited the Changshengda Pharmacy on Xingguo Road in the newly built area, and the clerk was blunt about the health care products that can be swiped by the medical insurance card, and it also said that it can be exchanged for drugs.
Is this the case? On December 16, the staff of the Fund Supervision Division randomly selected a list of consumption of "1323.3 yuan" from the "Store Non-personal Swipe Card or Single Swipe Card Information Registration Form" for verification, which stated that the fee was "drug" and the purchase time was November 15, 2020. The reporter saw from the purchase receipt that the product information was two Kangjue electronic sphygmomanometers and a box of Jinshuibao capsules, a total of 1323.30 yuan. But the reporter found in the sales records of the store that it was catty. On November 15, the Kangjun le electronic sphygmomanometer showed that the number of banks changed from "2" to "-2". In addition, from the delivery table of the store, it was found that during the period from November 3 to November 18, 2020, there was no record of the delivery of the Kangjunle electronic sphygmomanometer to the warehouse. In other words, there was no distribution of the Kondule electronic sphygmomanometer on November 15. If there is no delivery, where is it sold?
Haili planning a road store: two small tickets hide cat grease
At 5 p.m. on December 16, the reporter went to the Wanli Management Bureau's Haili Planning Road store and found that there was an abnormal distribution situation. During the interview, the reporter learned that since the store has been operating since 2018, a total of 68 bottles of anointing brain fluid have been distributed into the warehouse, but 99 bottles have been sold. What's the problem?
Subsequently, the staff of the Fund Supervision Division verified the sales of the store on December 6 this year. The reporter saw on a sales receipt that at 5:34 p.m. on the same day, some consumers purchased a bottle of 10ml * 40 sticks of tranquilizing brain fluid, 2 boxes of 0.3g * 96s of Kangjue Le Liuwei Dihuang Pills, a total consumption of 336 yuan. Almost at the same time, the reporter saw in another sales receipt that 10ml * 40 pieces of tranquilizing brain fluid, 0.3g * 96s of Kangjue Le Liuwei Dihuang Pill did the return process, and at the same time purchased 2 boxes of 850mg * 130 tablets of "Yangshengtang brand natural vitamin", the price is also 336 yuan.
Progress: 3 stores terminated the contract Involving the collusion project will be filed and handled
On this matter, the Municipal Medical Insurance Bureau made a handling and replied to Dajiang Network as soon as possible after investigation and verification: Jiangxi Changsheng Da Pharmacy Co., Ltd. Nanchang Fenglin Avenue Store, the newly built Xingguo Road Store, and the Wanli Planning Road Store have placed, sold daily necessities, and replaced the items outside the medical insurance directory with projects in the medical insurance directory to declare medical insurance settlement. According to the spirit of the Notice on Strengthening the Management of Medical Insurance Agreements and Ensuring the Safety of the Fund (Medical Insurance Banfa [2018] No. 21), the Jiangxi Provincial Medical Security Bureau's 2019 Special Treatment Work Plan for Combating Fraud and Insurance Fraud (Gan Medical Insurance Fa [2019] No. 3), the Nanchang Medical Security Bureau's 2019 Special Treatment Work Plan for Combating Fraud and Insurance Fraud (Hong Medical Insurance Fa [2019] No. 3) and the Nanchang Basic Medical Insurance Designated Retail Pharmacy Service Agreement Paragraph 6 of Article 14 stipulates that the West Lake District Medical Insurance Administration Bureau, with which it signed the agreement, has terminated the medical insurance service agreement for the above three stores on December 17. The administrative department of medical security of the county (district) where the act of declaring medical insurance settlement involving the serial exchange of items will file a case for handling.
Jiangxi Changshengda Pharmacy Co., Ltd. Shuanggang West Street store is currently a non-medical insurance designated pharmacy, but it has passed the fixed-point assessment and is in the public stage. After verifying the report with the person in charge of the pharmacy, the Municipal Medical Insurance Bureau has cancelled the designated qualification of the store according to the regulations.
It is true that Jiangxi Happy People's Congress Pharmacy Chain Co., Ltd. Century Central City Store gave gifts such as shampoo thermos cups, and the medical security department of the county (district) of the territory has instructed the store to rectify immediately. In response to the problems reported this time, the bureau said that in the future, it will work with the county (district) medical security bureau to increase the intensity of on-site inspections, and further improve the intelligent audit system for the invoicing and inventory of designated pharmacies, make full use of the intelligent audit system of invoicing, sales and inventory of pharmacies, and deal with the problems found in accordance with laws and regulations quickly.