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This article is reproduced from [China Voice of China Central Radio and Television];

Recently, an insider reported to the China National Radio news hotline 4008000088 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; these "patients" were given oxygen, infusions, and medications during the so-called "hospitalization", but in fact the oxygen was released and the infusions and nebulized medications were thrown directly into the trash.

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?

Hospital beds are "full"

There are only a few inpatients

Beijing Chemical Industry Occupational Disease Prevention and Treatment Institute, also known as Beijing Occupational Disease Prevention and Treatment Research Institute, is a Class-A Grade II occupational disease specialty hospital with two campuses.

Dr. Li (pseudonym), a hospital employee, told reporters that although the more than 60 beds in the inpatient department of the Xiangshan campus are often "full", there are few actual patients with occupational diseases who are hospitalized.

Doctor Li: Generally, there are forty to fifty "patients" hospitalized, and one cycle of hospitalization lasts 56 days. After being discharged, they stay for a week or two, and then the nurse notifies them to come back for "hospitalization". They stay in the hospital four to five times a year.

Doctor Li introduced that most of the patients hospitalized here are coal miners suffering from pneumoconiosis, most of whom are over 60 years old. Most of them suffer from grade II and grade III pneumoconiosis, and their hospitalization time ranges from more than 40 days to 56 days. According to the treatment conditions of the patients registered in the hospital, most of them are arranged with oxygen inhalation, infusion, nebulization, expectoration and other projects every day.

A video shot in June this year showed that from the system for checking bed availability within the hospital, it could be seen that there were 51 patients hospitalized at the time, but the actual number of hospitalized patients was only 2, and the rest of the "patients" were not there. However, these "patients" were receiving treatment and being billed every day.

The videos and pictures obtained by the reporter at multiple time points almost all showed similar situations. The hospital system recorded that many patients were hospitalized, but in fact the wards were empty.

Doctor Li: There are 18 patients in the respiratory department and 26 patients in the occupational disease department. It is 4:30 in the afternoon. I see a random patient. He has been breathing oxygen for 18 hours. The patient is not here. What should I do? The whole corridor is quiet. There is no patient in the ward now.

So, where did the infusions and other therapeutic drugs prescribed to the "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.

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: He just stayed in bed. These cases are made up, and the number of days is changed based on the first time.

"Patients" frequently take advantage of regulatory loopholes to prescribe drugs

Hundreds of visits in more than 90 days

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

Through information sharing among multiple hospitals in Beijing, the reporter saw that from February 6 to May 13, 2024, the "patient" Wang went to the outpatient clinics of major hospitals in Beijing to get prescription medicines a total of 104 times.

Take April as an example:

On April 3 alone, Wang went to three hospitals: Guang'anmen Hospital of China Academy of Chinese Medical Sciences at 8 a.m., No. 731 Hospital at 9:30 a.m., and Beijing Yanhua Hospital at 2:30 p.m., where he was prescribed medicines worth 827 yuan, 686 yuan, and 1,199 yuan respectively. The "diagnosis" included clavicle fracture, difficulty walking, chest injury, bronchial asthma, and coal worker's pneumoconiosis.

On April 4, at the Beijing Chemical Occupational Disease Prevention and Treatment Institute, five prescriptions were issued for a total of 1,319 yuan;

On April 6, at the China-Japan Friendship Hospital, two prescriptions were issued for a total of 1,824 yuan;

On April 7, at Peking University First Hospital, two prescriptions were issued for a total of 1,020 yuan;

……

Wang went to the hospital to get medicine almost every day, and all the money was paid by "work injury insurance". The medicines included over-the-counter medicines such as calcium carbonate D3, Lanqin oral liquid, cold and heat granules, as well as prescription medicines such as Ruyi Zhenbao pills, Feili cough mixture, and loxoprofen sodium.

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

Doctor Zhao (pseudonym), who once worked at the Beijing Chemical Occupational Disease Prevention and Treatment Institute for many years, said that when ordinary patients use medical insurance funds to get prescription drugs, they cannot get repeated prescriptions within the fixed drug use period, but work-related injury insurance is managed by the human resources and social security department, and the prescription period is not restricted.

Doctor Zhao: The medical insurance system does not include work-related injury insurance, and there are no strict restrictions on prescribing drugs with work-related injury insurance. The Beijing Chemical Industry Occupational Disease Prevention and Treatment Institute exploited a policy loophole and the "patient" was hospitalized for 56 days and spent nearly 50,000 yuan before being discharged. Because if the amount exceeds 50,000 yuan, the supervision will be strengthened.

Dr. Zhao revealed that there are many "regular customers" at the Beijing Chemical Industry Occupational Disease Prevention and Treatment Institute, most of whom are "pneumoconiosis patients." These people do not need to receive special hospitalization treatment, but are hospitalized many times a year. In addition to being almost unrestricted in prescribing medicine, they can also enjoy subsidies every day.

Doctor Zhao: According to the Work Injury Insurance Regulations, these "patients" receive a daily meal allowance during their hospital stay. This way, leaders can also have performance reports, such as how many patients I have received and how much I have contributed to occupational diseases. In addition, it is a public hospital with a large number of patients and beds, so many benefits can be applied for.

Director Huang of the Medical Affairs Department of Beijing Chemical Occupational Disease Prevention and Treatment Institute communicated with reporters and said that the hospital is frequently inspected and no such cases were found. "We are a second-level public hospital that receives state funding, so there is no need to do such things. The regulatory authorities come to inspect every year and conduct unannounced visits from time to time, but they have never found such cases in our hospital. As a staff member of the hospital management department, I have not found such cases either."

Expert: Work-related injury insurance and medical insurance catalog are consistent

Should be subject to matching regulatory mechanisms

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 Bureau and the Medical Security Bureau. In addition to work-related injury insurance, the Human Resources and Social Security Bureau is 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 Security Bureau.

Zhang Xiao: Medical insurance supervision is making steady progress, but there are many loopholes in work-related injury insurance. Due to large regional differences, the "Work-related Injury Insurance Regulations" vary greatly from place to place, and the policy is imperfect.

Zhang Xiao believes that this chaos not only wastes public funds, but also harms the interests of workers who are really in need of help. The basic medical catalogues of work-related injury insurance and medical insurance are consistent, and the supervision they receive should also match. "After the work-related injury is confirmed, the management has not kept up. The relevant departments should improve supervision and work together."