Zhangzhou Pientzehuang pharmaceutical is a precious pharmaceutical, with each pill selling between 700 and 1000 yuan. Due to the high stock price, the sales volume of general pharmacies is usually not large. Recently, a small pharmacy in Huangpi District of Wuhan sold more than 300 pieces of Zhangzhou Pientzehuang in a few months, attracting the attention of the medical insurance department, which later transferred the clues to the police.

Hubei Wuhan police reported that after investigating the pharmacy, they found that the more than 300 pieces of Zhangzhou Pientzehuang sold were mostly purchased using medical insurance cards from other regions, with sales amounting to over 200,000 yuan. This case involved a cross-provincial fraud of medical insurance funds by a criminal gang involved in the whole process of 'receiving cards, swiping cards, cashing out, mailing, and selling,' with implications in 21 provinces and cities across the country, involving an amount of over 2 million yuan, and resulting in the arrest of 22 criminal suspects. Currently, the case has entered the prosecution stage.

"How is cashing out with medical insurance cards achieved" may be seen from this case.

Under interrogation by Wuhan police, the owner of the above-mentioned pharmacy, Zhou, confessed that in January 2023, a man called to inquire if the pharmacy sold Zhangzhou Pientzehuang and requested providing medical insurance card information for remote drug purchases. Although Zhou knew this method was against the rules, he agreed for personal gain.

Subsequently, the man frequently contacted Zhou to purchase drugs online. When the medicines accumulated to a certain quantity, he would send them to a designated location in Guangdong through express delivery. Soon, the police found the cardholder through the implicated medical insurance card and eventually located the man, Li, suspected of operating the medical insurance card cash-out scheme.

According to Li's confession, starting from January 2023, he collected personal medical insurance card information under the guise of cashing out with medical insurance cards. He then remotely swiped the medical insurance cards to purchase drugs from pharmacies. The drugs obtained were resold to his downstream member, Liang, through which he illegally cashed out funds from the medical insurance card and profited.

"The price of one piece of Zhangzhou Pientzehuang is 760 yuan. Li sells it to others at ninety percent of the price, with the cardholder earning sixty percent and he taking thirty percent," said the police handling the case. Through further investigation, the police obtained more than 80 related clues, involving 21 provinces and cities across the country, with the amount of money involved exceeding 2 million yuan.

Peking Yunting Law Firm partner Lawyer Wu Gang expressed to Blue Whale Finance that Zhangzhou Pientzehuang Pharmaceutical is currently not reimbursed by the national basic medical insurance fund for pharmaceuticals. The illegal actors in the above news used funds from insured individuals' accounts to purchase Zhangzhou Pientzehuang, thereby assisting insured individuals in cashing out.

"Insured individuals involved in this case should handle the following situations separately: For those who have sufficient evidence to prove that they are truly unaware and have had their personal medical insurance information deceived, administrative authorities should not impose administrative penalties according to the law. Otherwise, for those who knowingly participated in the aforementioned illegal activities, administrative authorities have the right to take relevant administrative punishment measures against them," Lawyer Wu Gang said.

In fact, the medical insurance fund consists of two parts: individual accounts and overall funds. The funds in individual accounts are also part of the medical insurance fund and are under medical insurance fund supervision, not to be freely used by insured persons.

Starting from September 1, 2022, individual account funds are managed on an accounting basis, insured persons cannot freely withdraw them, and can only be used to purchase drugs at designated hospitals or pay for their personal share.

The National Medical Insurance Administration has repeatedly pointed out that in recent years, with the continuous improvement of medical insurance reimbursement levels, the gradual expansion of the drug scope in the medical insurance catalog, especially the steady progress of the reform of the joint guarantee for employee medical insurance outpatient care, people can now buy and use medicines more conveniently, whether at hospitals, pharmacies, clinics, or even online, and get medical insurance reimbursement.

However, while the people enjoy the benefits and convenience brought by the universal healthcare policy, some unscrupulous individuals have started to have evil intentions, with many drug dealers inducing insured individuals to participate in drug transactions through 'high-priced repurchases'. This practice involves reselling drugs purchased by insured individuals after enjoying medical insurance reimbursement, which is considered as medical insurance 'reclaiming drugs'.

Industry insiders point out that some patients may sell drugs to 'drug dealers' by requesting doctors to prescribe more medication, consume a portion, and sell the rest. However, once some 'expired drugs', 'wrong drugs', or 'fake drugs' enter the market, it not only disrupts the order of the drug market, erodes the integrity of the medical insurance system, but also affects the treatment effectiveness of some patients.

It is worth noting that Lawyer Wu Gang pointed out that direct sales and indirect assistance in selling 'reclaiming drugs' for the purpose of defrauding medical insurance funds constitute fraudulent acts.

According to Article 41 of the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds, individuals who, with the purpose of defrauding medical insurance funds, resell pharmaceuticals while enjoying medical insurance benefits, receive returns in cash, goods, or other illegal benefits, resulting in losses to medical insurance funds, shall have their medical expenses settled online suspended for 3 to 12 months, and be fined double to five times the defrauded amount. If the amount involved is large and the circumstances are serious, it may also constitute the crime of fraud and lead to imprisonment.

In April 2024, the National Medical Insurance Bureau, the Supreme People's Court, the Supreme People's Procuratorate, the Ministry of Public Security, the Ministry of Finance, the National Health Commission, and other six departments jointly deployed a special rectification campaign on illegal and irregular issues related to medical insurance funds. Practices such as prescribing excessive medication, using medication beyond the authorized scope, and selling medical insurance pharmaceuticals have been identified as key areas for rectification.