Ten thousand handwritten prescriptions reveal the 'black hole' of medical insurance fund loss

2024-10-17

Recently, during a data screening by the National Healthcare Security Administration's big data center, it was found that 96 insured individuals purchased drugs from a pharmacy in Harbin, Heilongjiang Province, with a particularly large amount of money. The largest insured individual even purchased drugs worth over one million yuan in two years. This has attracted high attention from the National Healthcare Security Administration. From August 20th to 26th, the reporter followed the special flight inspection team dispatched by the National Medical Insurance Bureau to Harbin, Heilongjiang Province to conduct an investigation. The reporter searched the medical insurance drug catalog and found that the patient was taking Sukexin, a drug called Avaripopa Maleate Tablets, abbreviated as Avaripopa, which belongs to the national Class B reimbursement drug and is a special outpatient drug suitable for adult patients with chronic liver disease related thrombocytopenia who undergo elective diagnostic or surgical procedures. Usually taken for a short period of time before intervention therapy. Based on taking 3 tablets per day and eating normally for 5 days, this patient only needs one box in total to meet the preoperative medication requirements for interventional surgery. The patient told investigators that they have been taking this medication for a long time and take three tablets a day. According to statistics, within two years, the patient purchased about 160 boxes of 2400 tablets of Avaticagrelor with a unit price of 7140 yuan, exceeding one million yuan, and took a total of 800 days, far exceeding the clinically reasonable dosage. Wang Guiqiang, Director of the Infectious Diseases Department and Director of the Liver Disease Center at Peking University First Hospital, introduced that currently the hospital generally uses this drug for 5 to 10 days. At the same time, the positioning of the drug is also relatively clear, that is, it should be used before emergency and invasive procedures. After medication, the patient's platelets will rapidly rise, reaching the expected level. Therefore, this medication is not intended for long-term use. According to experts, it is necessary for doctors to diagnose and prescribe medication based on the condition at regular intervals to determine whether it is necessary to continue using the drug for treatment, as well as the duration and dosage of use, after undergoing interventional surgery with atorvastatin. So how was such a prescription for drugs that exceeded the clinical dosage written? According to the patient's account, for the past three years of illness, it was his son who went to the pharmacy to buy and retrieve medicine. So, Ding Dongxing, a special flying inspection investigator from the National Medical Insurance Bureau, communicated with the patient's son. The patient's son stated that he did not need a prescription when purchasing the above-mentioned medication at the pharmacy, and he prescribed the medication for three months at once. According to the investigation, there are tens of thousands of handwritten fake prescriptions in these four pharmacies in Harbin, Heilongjiang Province, with a total amount exceeding one billion yuan. At present, the National Healthcare Security Administration has transferred some of the issues discovered during the special flight inspection of pharmacies involving "special drugs" to local public security. We will also continue to monitor the progress of the case. (New Society)

Edit:Sun Jia Bin    Responsible editor:Li Yi

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