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This newspaper (reporter Li Danqing) reported that after the National Healthcare Security Administration's Fund Supervision Department interviewed relevant persons in charge of Yixintang Pharmaceutical Group Co., Ltd. in May this year, the National Healthcare Security Administration recently released the rectification situation of Yixintang Pharmaceutical Group, showing that the pharmaceutical group has returned more than 10.7 million yuan of medical insurance funds.

The reporter learned that this is the first time that the National Medical Insurance Administration has interviewed large designated retail pharmacies. The medical insurance department will maintain a comprehensive and strict tone, take multiple measures to strengthen supervision of designated retail pharmacies, and urge designated retail pharmacies to standardize their business operations from the beginning of using the pooling fund, and fasten the "first button" after entering the market.

In recent years, the country has established and improved a "dual-channel" management mechanism for medical insurance negotiated drugs, included designated retail pharmacies in outpatient coordination, and accelerated the promotion of direct settlement of cross-provincial medical treatment. More and more insured people can use their medical insurance code (social security card) to buy medicine at retail pharmacies near their homes.

"However, with the widespread promotion of medical insurance policies that benefit the people, the supervision of medical insurance funds also faces some new problems. Some designated retail pharmacies have engaged in illegal and irregular use of medical insurance funds, such as false prescriptions, drug substitution, and excessive prescriptions. Although the medical insurance department has promptly investigated and dealt with some illegal activities, it is more urgent to further strengthen the designated retail pharmacies' main responsibility for self-management." A relevant person in charge of the Fund Supervision Department of the National Medical Insurance Administration introduced.

According to regulations, if the medical insurance fund supervision policies are not fully implemented, serious problems in medical insurance fund supervision occur, or there are major hidden risks, the National Medical Insurance Administration may take measures such as letters of inquiry or interviews to urge and guide the relevant designated medical institutions to strictly fulfill their main responsibilities and implement rectification.

According to reports, in response to the requirements of the talks and the "Negative List of the Use of Medical Insurance Funds by Designated Retail Pharmacies in 2024" issued by the medical insurance department, Yixintang Pharmaceutical Group conducted self-inspection and self-correction on the use of medical insurance funds by 9,179 directly-operated chain medical insurance designated pharmacies across the group, focusing on five issues, including whether there are "false prescribing, substitution of drugs, excessive prescribing, conducting medical insurance settlement on behalf of other pharmacies, and daily management."

The person in charge revealed that some designated retail pharmacies illegally and irregularly use medical insurance funds mainly in the following situations: false prescribing, fabricating or forging drug prescriptions or sales records and swiping the medical insurance code (social security card) in vain; replacing drugs, replacing non-drugs with medical insurance drugs, replacing non-medical insurance drugs with medical insurance drugs, and replacing low-priced drugs with high-priced drugs; prescribing excessive amounts of drugs; and performing medical insurance settlement on behalf of other pharmacies.

The reporter learned that the medical insurance department will further strengthen the supervision of designated retail pharmacies, increase the intensity of unannounced inspections, and directly designate inspections for designated retail pharmacies with prominent suspicious problems found through big data screening. At the same time, it will strengthen the application of technical means, continue to carry out daily supervision, explore the establishment of a credit management system for the heads of designated retail pharmacies, and take credit management measures for the heads of designated retail pharmacies with more serious problems.