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According to the China News Service of China National Radio, work-related injury insurance, as an important part of the "five insurances and one fund", refers to the necessary material compensation that workers or their families can obtain from the state and society when they suffer accidental injuries or occupational diseases at work or under special circumstances, resulting in temporary or permanent loss of working ability or death. This compensation includes both medical expenses and rehabilitation expenses, as well as the cost of ensuring basic living.

However, an insider reported to the China Voice news hotline 400-800-0088 that the Beijing Chemical Occupational Disease Prevention and Treatment Institute regarded the reimbursement amount of work-related injury insurance as "Tang Monk's meat". For a long time, computer information showed that dozens of people were hospitalized for occupational diseases every day, but in fact, only a few people lived in the ward; during the so-called "hospitalization", these patients inhaled oxygen, received infusions, and took medicines, but the oxygen was released and the infusions and nebulized medicines were thrown directly into the trash can.

People familiar with the matter also reported that some patients who were identified as having suffered work-related injuries were actually in relatively stable physical conditions, but they treated the work-related injury insurance fund as a "cash machine". Some patients went to hundreds of hospitals for prescription medication in more than 90 days. Is such behavior suspected of defrauding the work-related injury insurance fund? Why has the relevant supervision failed to keep up?

Beijing Chemical Industry Occupational Disease Prevention and Treatment Institute (also known as Beijing Occupational Disease Prevention and Treatment Research Institute) is a Class II Grade A occupational disease specialty hospital. Hospital employee Dr. Li told reporters that the hospital has two campuses. In the inpatient department of the Xiangshan campus, although the more than 60 beds are often "full", there are few actual occupational disease patients hospitalized.

Doctor Li said: "There are usually 40 to 50 inpatients, and each cycle lasts 56 days. After the patients have been admitted, they are asked to stay out for a week or two, and then the nurse will notify them to come back for another hospitalization. They should stay in the hospital four or five times a year, and have their blood drawn normally. After that, they disappear."

Doctor Li told reporters that most of the patients who come here for hospitalization are coal miners suffering from pneumoconiosis, and they are generally over 60 years old. Most of them suffer from second- and third-grade pneumoconiosis, and their hospitalization time ranges from more than 40 days to 56 days. According to the treatment of patients registered in the hospital, most of them will be arranged for oxygen inhalation, infusion, nebulization, expectoration and other projects every day.

Dr. Li said: "The doctor's orders required oxygen and other treatments, but they were not there. They only charged the bill. The budesonide (nebulizer) they prescribed was not infused at all. The nurses cut up all the medicines and threw the medicine bags directly into the trash can."

Cut off infusion bag

A video shot in June this year and obtained by the reporter showed that from the system for checking bed status inside the hospital, it could be seen that there were 51 patients hospitalized at the time, while the actual number of hospitalized patients was 2.

Doctor Li introduced: "There are currently 20 patients in the respiratory department, 30 in the occupational disease department, and one patient with medical insurance in the general internal medicine department, with a total of 51 inpatients. The real inpatients are the patients with medical insurance and the patients with one bed. Other patients are not here, and many patients are receiving treatment. Every patient is receiving oxygen inhalation, mechanical assisted expectoration, expectorant and lung clearing device, including comprehensive lung function training, which is charged every day."

The same situation occurred one day in mid-June: the system showed that the beds were almost full and all patients were receiving treatment, but the actual situation was quite different.

Doctor Li said: "There are 18 patients in the respiratory department of the ward and 26 in the occupational disease department. I randomly see a patient who needs oxygen inhalation for 18 hours. The patient is not here and cannot be operated. The whole corridor is silent. There is not a single patient in the whole ward now."

The system shows that the ward is full, but in fact it is empty

The videos and pictures obtained by the reporter at multiple time points almost all show that the hospital system recorded that many patients were hospitalized and various treatment methods were being used, but in fact the wards were empty.

Where did the infusions and other therapeutic drugs prescribed for hospitalized patients go? A video showed that the sodium chloride infusion bags that should have been twisted open at the bottom were cut open with scissors and thrown into the trash.

The system shows that the beds are full, and many patients have been hospitalized dozens of times.

These patients have one thing in common: their treatment costs come from the work-related injury insurance fund. The reporter randomly checked the information of two patients, one of whom was hospitalized 23 times and the other 34 times, each time for 40 to 50 days.

Doctor Li said, "It's just hanging here. These cases are all made up, and they were revised based on the first time."

In addition to empty lists of patients, some patients also take advantage of regulatory loopholes and frequently get prescription drugs in the outpatient clinics of major hospitals in Beijing.

Wang prescribed Lancen oral liquid and other over-the-counter drugs

Through information sharing among multiple hospitals in Beijing, the reporter saw that from February 6 to May 13, 2024, patient Wang Moumou went to the outpatient clinics of major hospitals in Beijing for prescriptions 104 times. Take April as an example. On April 3 alone, Wang Moumou went to three hospitals: Guang'anmen Hospital of China Academy of Chinese Medical Sciences at 8 a.m., Aerospace 731 Hospital at 9:30 a.m., and Beijing Yanhua Hospital at 2:30 p.m., traveling nearly 50 kilometers, and prescribed drugs worth 827 yuan, 686 yuan and 1,199 yuan respectively. The "diagnosis" included clavicle fracture, difficulty walking, chest injury, bronchial asthma, coal workers' pneumoconiosis, etc. On April 4, the patient came to Beijing Chemical Occupational Disease Prevention and Control Institute to issue 5 prescriptions totaling 1,319 yuan, 2 prescriptions totaling 1,824 yuan at China-Japan Friendship Hospital on April 6, and 2 prescriptions totaling 1,020 yuan at Peking University First Hospital on April 7... Wang Moumou went to the hospital to get medicine almost every day, and all the payment was "work injury insurance." The medicines include over-the-counter drugs such as calcium carbonate D3, Lanqin oral liquid, and cold and heat-clearing granules, as well as prescription drugs such as Ruyi Zhenbao Pills, Feili Ke Mixture, and loxoprofen sodium.

Part of Wang's medical records

Dr. Zhao, who worked at the Beijing Chemical Industry Occupational Disease Prevention and Treatment Institute for many years, also confirmed this to the reporter. Dr. Zhao said that the drug catalog for work-related injury insurance is the same as that for medical insurance, but it is not supervised by the Medical Security Bureau. When ordinary patients use medical insurance funds to prescribe medicine, they cannot prescribe the same medicine within the fixed use period of the medicine. However, work-related injury insurance is managed by the human resources and social security department, and the prescription period is not restricted.

Dr. Zhao said: "Regarding prescribing medicine, if it is a work-related injury, there are not many restrictions. This is a loophole in the medical insurance system that does not include work-related injuries. The Beijing Chemical Occupational Disease Prevention and Treatment Institute exploited the policy loophole. Patients spend less than 50,000 yuan and stay in the hospital for 56 days. Basically, they spend nearly 50,000 yuan before being discharged. If it exceeds 50,000 yuan, the supervision from above will be strengthened."

Dr. Zhao told reporters that there are many "regular customers" at the Beijing Chemical Occupational Disease Prevention and Control Institute, most of whom are patients with pneumoconiosis. However, these people rarely need to receive special hospitalization treatment, but are hospitalized many times a year. In addition to having almost no restrictions on prescribing medication, they can also enjoy subsidies every day.

Doctor Zhao said: "The patients go home after one visit. There used to be a list of about 70 to 80 'regular residents'. These drugs are prescribed to prove hospitalization, not to allow infusion. According to the Regulations on Work Injury Insurance, even if the patient is hospitalized, there is a daily meal allowance. Leaders also have performance reports. How many patients have they received? How much contribution have they made to patients with occupational diseases in terms of medical care? Otherwise, if there are no patients, what have they done for patients with occupational diseases? This is a public hospital. Based on the number of patients and beds, many welfare benefits can be applied for."

When communicating with reporters, Director Huang of the Medical Department of Beijing Chemical Occupational Disease Prevention and Control Institute said that the hospital undergoes regular inspections and has not found such cases.

Director Huang: We are a second-level public hospital, so there is no need for us to do this. We receive funding from the state. If there is an indication for hospitalization, we admit the patients from the outpatient department. After admission, we will definitely follow the normal examinations and treatment. The regulatory authorities related to work-related injuries come to inspect every year, and conduct unannounced inspections from time to time, but they have not found such a situation in our hospital. At least as a member of the management department, I have not found such a situation.

Regarding the issue of work-related injury insurance, Zhang Xiao, director of the Department of Medical Insurance at the School of Public Health of Southeast University, believes that the drug catalogs of work-related injury insurance and medical insurance are the same, but the supervision is respectively handled by the local human resources and social security departments and the medical insurance departments. In addition to work-related injury insurance, the human resources and social security departments are also responsible for pension insurance, unemployment insurance, professional skills appraisal and other tasks. The coordination strength of each province and city varies. Some provinces only completed the coordination of the province's work-related injury insurance funds at the beginning of this year, and the supervision strength is not as strong as that of the medical insurance bureau.

Zhang Xiao said: "The current basic medical catalog is integrated, but in terms of policy, work-related injuries have some special features, and the line of medical insurance supervision should move forward steadily. There are still many loopholes in work-related injuries. Because of the huge regional differences, the implementation of regulations related to work-related injuries varies greatly in various places, which is the reason for the imperfect policy."

Zhang Xiao believes that such behavior not only wastes public funds, but also harms the interests of workers who are injured at work and really need help. The basic medical catalogues of work-related injury insurance and medical insurance are consistent, and the supervision they receive should also match.

Zhang Xiao said: "The work injury policy is not perfect, and after the work injury is fully confirmed, there is no follow-up in management. Supervision needs to be improved, and there should be linkage and coordination. Once some policies are released, both sides will be linked because the catalogues and standards used are the same."