Pharmacies have repeatedly banned the illegal use of medical insurance funds: Yixintang was interviewed again in 2018, and it was exposed by CCTV

National Business Daily

2024-06-02 21:52Posted on the official account of Sichuan Daily Economic News

Reporter: Chen Xing Editor: Yang Xia

According to the WeChat official account of the National Health Insurance Administration on June 2, on May 24, the Fund Supervision Department of the National Health Insurance Administration interviewed the relevant person in charge of Yixintang Pharmaceutical Group Co., Ltd. (hereinafter referred to as "Yixintang").

Image source: WeChat public account of the National Health Insurance Administration

The interview pointed out that the medical insurance department found in the fund supervision work that some of Yixintang's designated chain stores had problems such as collusion of drugs, over-prescribing drugs, medical insurance settlement on behalf of designated retail stores that suspended medical insurance settlement, mismatch of drug purchase, sale and inventory records, and non-standard sales of prescription drugs, resulting in losses to the medical insurance fund.

The reporter noted that this is not the first time that Yixintang has been fined for using medical insurance funds in violation of laws and regulations. As early as 2018, Yixintang's pharmacy was reported by CCTV's "Economic Half Hour" that there was a problem of illegal use of medical insurance funds. Before being interviewed this time, Yixintang also had sporadic stores that were fined for illegal use of medical insurance funds.

By the end of last year, the number of Yixintang stores had exceeded 10,000. A number of industry insiders said that the frequent illegal use of medical insurance funds by Yixintang has exposed the management problems of Wandian pharmaceutical retail chain enterprises on the one hand, and on the other hand, with the addition of designated retail pharmacies to outpatient medical insurance co-ordination, the supervision of medical insurance funds has also posed challenges.

He was interviewed for the typical illegal use of medical insurance funds 

According to the WeChat official account of the National Health Insurance Administration on June 2, 2024, on May 24, 2024, the Fund Supervision Department of the National Health Insurance Administration interviewed the relevant person in charge of Yixintang Pharmaceutical Group Co., Ltd. (hereinafter referred to as "Yixintang").

The interview pointed out that the medical insurance department found in the fund supervision work that some of Yixintang's designated chain stores had problems such as collusion of drugs, over-prescribing drugs, medical insurance settlement on behalf of designated retail stores that suspended medical insurance settlement, mismatch of drug purchase, sale and inventory records, and non-standard sales of prescription drugs, resulting in losses to the medical insurance fund. The above problems violate Articles 38, 39 and 40 of the Regulations on the Supervision and Administration of the Use of Medical Security Funds and the relevant contents of the territorial medical insurance service agreement.

When answering reporters' questions on the interview, the relevant person in charge of the Fund Supervision Department said that from the perspective of the supervision of medical insurance funds in various places, some designated chain stores under Yixintang have more typical illegal use of medical insurance funds. Considering that Yixintang has many stores and a large amount of medical insurance funds, in order to prevent greater problems, the Fund Supervision Department of the National Health Insurance Administration interviewed Yixintang and urged it to strengthen management, standardize behavior, earnestly fulfill the main responsibility, and better maintain the safety of the medical insurance fund.

The person in charge of Yixintang said that the problems pointed out in this interview are an important wake-up call for the company. In the next step, Yixintang will adhere to the problem-oriented, set up a working group in accordance with the requirements of the interview, and standardize the operation of its chain stores with substantive rectification measures. According to the requirements of the interview, Yixintang will submit a rectification report to the Fund Supervision Department of the National Health Insurance Administration before the end of June.

It is worth noting that after May 22, Yixintang's share price continued to fall. On the same day, Yixintang closed at 22.26 yuan shares, and as of the close of trading on May 31, Yixintang closed at 20.75 yuan shares.

At present, how is Yixintang store managing the use of medical insurance? On the afternoon of June 2, the reporter of "Daily Economic News" visited a number of Yixintang stores in Chengdu as a consumer. A number of clerks said, "In the past, health care products and skin care products could be covered by medical insurance, but now they are strictly controlled." However, when the clerks of two stores heard that the reporter wanted to use the medical insurance card to consume, they both recommended buying prescription drugs instead of the health care products that the reporter asked.

The chairman of the board of directors has publicly stated that he will maintain the safety of the medical insurance fund

In 2019, Ruan Hongxian, chairman of Yixintang, also publicly stated that as a local pharmaceutical company, Yixintang has the responsibility to fully support the state in combating fraud and insurance fraud, maintain the safety of the medical insurance fund, and never let the medical insurance fund become a new "Tang monk meat".

However, the reporter noticed that as early as 2018, Yixintang's pharmacy was named and criticized for arbitraging medical insurance funds.

On the evening of March 27, 2018, CCTV's financial channel "Economic Half Hour" reported that the medical insurance card of the "Yixintang" chain pharmacy in Sanya City, Hainan Province, was used as a consumption card to purchase non-drugs, as well as issued false invoices, suspected of arbitraging social security funds.

According to the report, in Jiefang Road and other places in Sanya City, more than a dozen Yixintang medical insurance designated pharmacies have become department stores and supermarkets, and customers can use medical insurance cards to buy drugs directly. The price of these daily necessities not only exceeds the normal market price, but in the issuance of invoices, this pharmacy also uses the technique of "tanuki for prince".

Yixintang also issued an announcement that night, admitting that 14 stores of its wholly-owned subsidiary, Hainan Hongxiang Yixintang Pharmaceutical Chain Co., Ltd., had violated regulations to allow customers to use medical insurance cards to purchase non-medical insurance products, and there were loopholes in the management of Hainan Yixintang.

According to the company, the medical insurance qualifications of the stores suspected of illegal card swiping are Heilongjiang medical insurance and Harbin medical insurance personal accounts, which are set up to facilitate the use of medical insurance by Heilongjiang people because a large number of Heilongjiang card-holding customers live in Hainan every year.

Subsequently, Yixintang released the follow-up progress of the incident three times. The company disclosed in the announcement that Hainan Yixintang has undertaken 10 direct medical insurance ports in Heilongjiang Province since September 2015, and from September 2015 to March 27, 2018, a total of 105,500 direct medical insurance card swipes in Heilongjiang Province, with a total amount of 5.5117 million yuan, including 1,610 non-compliant card swipes, involving an amount of 118,800 yuan. Since September 2015, it has undertaken 13 medical insurance ports in Harbin, and from September 2015 to March 27, 2018, a total of 2,000,500 Harbin medical insurance card swipes have been swiped, with a total amount of 21.67 million yuan, including 8,106 non-compliant card swipes, involving an amount of 539,200 yuan, mainly using personal accounts to sell daily necessities in violation of regulations.

Even though the incident has led to multiple penalties, there have been similar incidents at Yixintang's pharmacy since then. In December 2022, in the random inspection and review of relevant departments, it was found that there were some large amounts of unregistered, incomplete prescription drugs and discrepancies in the purchase, sale and inventory of Sichuan Yixintang Pharmaceutical Chain Co., Ltd. Longchang Golden Goose Rehabilitation Middle Road Store, involving a violation of 3153.88 yuan affecting the interests of the insured, according to the provisions of the "Neijiang City Medical Security Designated Medical Institution Service Agreement", 3153.88 yuan of illegal fees were recovered, and 1147.80 yuan of liquidated damages were imposed, and the person in charge of the pharmacy was interviewed and required to be rectified immediately.

In terms of the number of stores, Yixintang, once known as the "merger and acquisition maniac", has tens of thousands of stores. As of December 31, 2023, Yixintang had 10,255 directly operated chain stores, and 1,381 new stores were opened throughout the year, with a net increase of 1,049 stores.

On the morning of June 2, the reporter called Ruan Hongxian, chairman of Yixintang, several times to learn about the matter but was hung up, and then the reporter sent the question to the other party's WeChat, but did not receive a reply as of press time.

Designated retail pharmacies are included in the scope of outpatient coverage, and regulatory tasks and pressures have intensified

The illegal use of medical insurance funds by retail pharmacies has become a stubborn problem in the industry. In recent years, the National Health Insurance Administration has repeatedly exposed the illegal use of medical insurance funds by pharmacies.

The relevant person in charge of the Fund Supervision Department of the National Health Insurance Administration said that from the perspective of medical insurance fund supervision practice, some designated retail pharmacies use medical insurance funds in violation of laws and regulations mainly in the following situations: false prescription, collusion of drugs, over-prescribing of drugs, and medical insurance settlement and management for other pharmacies.

Image source: Official website of the National Health Insurance Administration

In March last year, the National Health Insurance Administration issued the "Notice on Further Improving the Inclusion of Designated Retail Pharmacies in the Overall Management of Outpatient Clinics", clarifying that medical insurance departments at all levels should take effective measures to encourage eligible designated retail pharmacies to voluntarily apply for outpatient co-ordination services.

Huang Xiuxiang, former secretary general of the Hunan Pharmaceutical Circulation Association, said in an interview with the reporter of "Daily Economic News" that the balance of funds in the outpatient co-ordination account also allowed some people to use the medical insurance fund in violation of regulations out of the mentality of "not in vain".

Taking Hunan Province as an example, he said that in 2023, there should be more than 9 billion yuan in the outpatient co-ordination account in Hunan Province, and nearly 4.3 billion yuan of funds will be used, while more than half of the unused funds will not be accumulated or transferred, and finally enter the co-ordinated account. In the past, if the funds in the personal account were not used up, they could be accumulated in the account. This has caused some people to use up in designated retail pharmacies in a surprise manner when the outpatient overall reimbursement amount is not used up, and pharmacies and clerks tend to be performance pressure and profit-seeking, and together they have completed the illegal use of medical insurance funds.

Huang Xiuxiang believes, "From the data of medical insurance personal accounts, in fact, everyone will be more careful in their calculations. For outpatient pooled accounts, there is an almost 'take advantage' mentality. Therefore, it is our suggestion to make the money in the outpatient co-ordination account accumulate, deduct the reimbursement amount used every year, and make a proportional balance to establish a self-motivation and restraint mechanism."

He also said that for pharmaceutical retail companies, the most important thing is to establish a high-voltage red line. Abnormalities in the use of medical insurance funds in a certain store and in a certain period of time can be monitored through data. When this happens, enterprises should give early warning and intervene in time.

The reporter noted that in April this year, six departments including the National Health Insurance Bureau carried out special rectification work on violations of laws and regulations in the medical insurance fund. The above-mentioned working document clearly mentions that with the implementation of the outpatient co-ordination policy, while serving the masses and facilitating the masses, the regulatory tasks and regulatory pressure have increased dramatically, and it is necessary to grasp the early and small.

In the next step, the National Health Insurance Bureau will also conduct interviews with relevant institutions that have serious problems found in the inspection in combination with this year's unannounced inspection and special rectification.

(Cover picture source: Photo by Liu Guomei, National Business Daily)

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