Multiple settlements for a single box of medication! Affecting multiple provinces, there may be significant clues to illegal drug activities behind it.
2024.11.03
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First Financial News learned from the National Healthcare Security Administration that the repeated drug traceability codes for Compound Ejiao Syrup have affected multiple provinces, and there may be significant drug violation clues hidden behind this.
The drug traceability code covering hundreds of millions of data entries is becoming another "sharp sword" for big data supervision of medical insurance funds. By analyzing the repetition of drug traceability codes, the National Healthcare Security Administration reported a suspected event involving drug substitution, reflux, and counterfeiting across provincial medical institutions.
The National Healthcare Security Administration (NHSA) has issued a "Notice on Conducting Verification of Duplicate Drug Traceability Codes for Compound Ejiao Syrup" (hereinafter referred to as the Notice). The Notice states that recently, the NHSA received reports from enterprises and the public, and after analyzing the drug traceability codes uploaded by various regions, it discovered that some designated medical institutions were selling Compound Ejiao Syrup produced by Dong'e Ejiao Co., Ltd. with duplicate drug traceability codes, all of which involved medical insurance fund settlements. The cases of duplication involving more than or equal to one time occurred in medical institutions across 21 provinces.
First Financial News learned from the National Healthcare Security Administration that the repeated drug traceability codes for Compound Ejiao Syrup have affected multiple provinces, potentially hiding major drug violation clues. The National Healthcare Security Administration has requested relevant healthcare security departments to conduct investigations and report the investigation results to the National Healthcare Security Administration by the end of the month.
Big data regulation is the development direction of medical insurance fund supervision and also the manifestation of new qualitative productivity in the medical insurance field. Liao Zangyi, an associate professor at the School of Politics and Public Administration, China University of Political Science and Law, told the First Financial News that data is an important element of new qualitative productivity. Based on the vast amount of medical insurance data, the drug traceability code, which assigns a unique digital code to each box of medicine, can effectively prevent illegal activities such as drug swapping, returned drugs, and counterfeit drugs. This not only ensures the safety of the medical insurance fund but also guarantees the quality of medication for patients.
A box of compound gelatin paste is settled more than once
The drug traceability code is the "electronic ID card" of the drug, usually consisting of a series of numbers, letters, and/or symbols, prominently marked on the drug packaging box. It is a unique identity label assigned to each box of drugs at the time of production. If duplicate drug traceability codes are found during the distribution process, it may indicate the presence of counterfeit drugs, returned drugs, or the possibility of drugs being swapped for sale.
The announcement lists three types of violations regarding the repetition of traceability codes for Compound Ejiao Syrup. The first is suspected swapping, where the same drug traceability code is repeatedly settled at the same designated medical institution. The second is suspected return of drugs or using the same drug to fraudulently charge different insured individuals' medical insurance cards, where the same drug traceability code is settled at different designated medical institutions with a significant time span. The third is suspected counterfeit drugs, where the same drug traceability code is settled at different designated medical institutions in close proximity in time.
The National Healthcare Security Administration released the "Duplicate Trace Codes for Compound Ejiao Syrup" along with the announcement. The table lists nearly a hundred violation records, with suspected substitution information accounting for %, involving multiple clinics, village health centers, pharmacies, and private medical institutions in provinces such as Shandong, Shaanxi, and Anhui. The hospital with the most duplicate trace codes is Laixi Hanshi Hospital in Qingdao, Shandong, totaling up to a hundred codes.
Taking the drug traceability code "" listed in the bulletin as an example, this single traceability code was settled times in this hospital, with settlements occurring on the date of under the names of multiple insured individuals, and multiple instances of settlements occurring within the same minute.
Liao Cangyi stated that the drug traceability code enables full-process tracking from production, circulation, to consumers. Each scan records an application scenario, and repeated use multiple times may involve illegal activities such as drug swapping, returned drugs, and counterfeit drugs.
Zhao Heng, founder of a healthcare strategy consulting firm, told Yicai that previously, it was difficult for regulators to obtain evidence for similar fraudulent insurance claims. Now, the drug traceability code has become a key tool. The drug traceability code provides full-process traceability of sales activities by pharmacies and medical institutions, which helps in comprehensive supervision of the medical insurance process and prevents fraudulent insurance claims.
Strengthen supervision of drug circulation
Compound Ejiao Syrup is a Class B medical insurance product. When it was first included in the medical insurance catalog, its indication was limited to patients with severe anemia. In the new version of the catalog, the restriction "limited to patients with severe anemia test evidence" was removed. According to data from Mi Nei Net, in the first half of the year, the sales of Compound Ejiao Syrup in physical pharmacies in Chinese cities alone increased by .%, reaching . billion yuan.
On the evening of the day, Dong'e Ejiao released a statement titled "Declaration on Actively Responding to the Announcement of the National Healthcare Security Administration" on the official microblog of the National Healthcare Security Administration. The statement reads: "All compound Ejiao paste products produced by Dong'e Ejiao are executed in accordance with relevant national laws and regulations, strictly adhering to the principle of one drug, one code. The phenomenon of repeated traceability codes mentioned in the National Healthcare Security Administration's 'Announcement on Verifying the Situation of Repeated Traceability Codes for Compound Ejiao Paste' is not due to our company."
Deng Yong, director of the Health Law Research and Innovation Transformation Center at Beijing University of Chinese Medicine, told Yicai that the discovery of repeated traceability codes in compound Ejiao syrup sold by some designated medical institutions is highly unusual and may indicate serious issues in the drug distribution process. Moreover, the repeated cases involving more than or equal to times involve medical institutions in provinces across the country, indicating that this problem is not an isolated incident but exists within a certain scope, covering a wide geographical area and having a significant impact.
The National Healthcare Security Administration requires that in cases involving the substitution of items, the sale of returned drugs, or the unauthorized use of another person's medical insurance card, individuals should voluntarily report to the local medical insurance authorities, refund the medical insurance funds, and accept penalties. If counterfeit drugs are suspected, they should be promptly reported to the National Healthcare Security Administration and copied to Shandong Dong'e Ejiao Co., Ltd.
Deng Yong stated that the National Healthcare Security Administration has requested a nationwide verification of the traceability codes for Compound Ejiao Syrup. This measure aims to comprehensively investigate issues, clarify responsibilities, and strengthen oversight of designated medical institutions. Simultaneously, investigating abnormal situations in medical insurance fund settlements helps prevent and combat medical insurance fraud, safeguard the security and stability of medical insurance funds, and ensure the sustainable development of the medical insurance system.
Drug traceability codes empower medical insurance fund supervision
In recent years, many local medical insurance departments have cracked down on multiple major cases involving the black market chain of "returned drugs," which seriously threaten public medication safety and the security of medical insurance funds. The drug traceability code, based on the intelligent risk control model for medical consumables, can effectively monitor the scanning of drug codes by pharmacists, achieve secondary sales interception, prevent the return of drugs, and block the swapping of drugs.
The nationwide unified medical insurance information platform has been completed, laying the foundation for the implementation of big data applications. Medical insurance is being empowered by information technology to drive the transformation of fund supervision towards digital supervision, continuously enhancing the quality and efficiency of supervision. The "Annual Work Plan for Special Rectification of Illegal and Irregularities in Medical Insurance Funds" (Medical Insurance Issue [Year] No.) particularly emphasizes in strengthening data empowerment, "enhancing the application of drug traceability codes, constructing multi-dimensional big data models, and promoting breakthroughs in big data supervision."
In this month, the National Healthcare Security Administration launched a pilot program for the collection of traceability code information for medical insurance drugs and consumables. Starting from this month, this work transitioned from a pilot phase to full-scale promotion, with the goal of implementing nationwide barcode scanning for inventory by the end of the year. As of this date, all provincial-level medical insurance information platforms have fully commenced the collection of traceability codes, with data aggregated reaching 2.8 billion entries, involving 3.4 million designated medical institutions (more than 95% of all institutions have begun collecting traceability codes) and 2.5 million designated retail pharmacies (more than 97% of all pharmacies have completed the task).
The verification of the repeated traceability codes of Compound Ejiao Syrup is the first time that the National Healthcare Security Administration has publicly investigated major illegal activities related to pharmaceuticals since the pilot work on collecting traceability code information for medical insurance drugs and consumables. This marks the first time that the drug traceability code has demonstrated its power in the supervision of medical insurance funds.
Liao Cangyi stated that to fully leverage the application of drug traceability codes as a new quality productivity in the healthcare field, it is necessary to further solidify data quality, establish a nationwide unified healthcare big data market, and precisely develop more big data models and rules capable of identifying unreasonable medical behaviors. This will provide data support for on-site inspection and precise verification of healthcare fund supervision, backed by sound reasoning and evidence.
