Shanghai Cracks Out Big Medical Care Fraud Case
In early April, the Shanghai police cracked a case of fraudulent medical care fraud, where doctors, nurses, doctors, investors, a huge organizational structure, and complex interest chains surfaced.
Recently, the Shanghai police successfully smashed an illegal drug-trafficking gang and arrested more than 160 people involved in the case, including 69 medical doctors, seized one simulated gun and more than 10 boxes of drugs.
The preliminary interrogation found that suspects Yi and Chen were behind the scenes, organized medical gangs, and later sought medical treatment for patients admitted to hospitals in Shanghai. Since March this year, the number of victims has reached 669.
Observe the situation and wait for the rabbit to catch the patient. Introduce one person to commission twenty or thirty yuan.
Zhou was one of the suspected suspects in medical care fraud. General Zhou got up more than 6 o'clock, 7 o'clock arrived at the Changshu Road subway station not far from the Shanghai Huashan Hospital, ENT hospital, wait and see.
"Some people may ask 'How does the Huashan Hospital go?' I asked people what's wrong with you. Then, my wife came to say, 'Huashan Hospital is not good, go to the Huaxin outpatient department to see it, I see there Several times just fine." Zhou said.
According to Shan Xuewei, deputy chief of the Shanghai Public Security Corps, the doctors are responsible for seducing other provinces and cities to come to Shanghai to seek medical advice. Visit a medical clinic under control for medical treatment.
"When the business is good, our two couples can earn 4,000 yuan per month, but when they are worse, they are more than 3,000 yuan." Zhou's wife Wu said, "Make a mention of 20 yuan or 30 yuan."
Suspected person Chen was twice arrested for security fraud due to medical care. Chen said: "In our circle, we all know that Yi Yi is Shanghai's largest boss. He is doing medical work for him."
According to reports, in a number of clinics controlled by Yi, one clinic has at least 50 medical doctors who help deceive patients, and doctors and hospitals rely on supporting teams to help each other. The head nurse is responsible for recruiting doctors, counting and paying doctors' commissions.
Open "prescription" to see the patient's economic strength, with "herbal tea" cure glaucoma
Yi confessed that the doctors, doctors' assistants, leading physicians, pharmacists, and nuclear price checkers in the clinics involved in the cases were involved. "Nuclear price is critical, and the patient's course of treatment will be determined based on the patient's condition and economic status reported by the 'advertiser' (medical care provider). To put it bluntly, it is determined how much money this clinic can deceive."
The young man from Hubei Province, Li Jingui, went to Shanghai Wuguan Hospital for glaucoma and was defrauded to Huaxin Chinese Medicine Clinic. The doctor simply made the lower pulse, looked at the tongue, and prescribed the prescription. After the prescription was opened, a man next to him took the list and told Li Jingui that there were more than 3,800 drugs.
After serving for 12 days, his eyes did not look good, but his stomach started to feel uncomfortable. Li Jingui went to a regular Chinese medicine hospital to find out that Huaxin's Chinese medicine outpatient department had almost the same herbal medicine as herbal tea, which is a kind of heat and purging, and it is impossible to treat glaucoma.
According to Yi Yi, all medical staff earned a base salary plus commission, doctors pulled their own patients, 10% for medical expenses, and 5% for medical patients. The clinics involved in the case declared to the public that "special treatment of incurable diseases" are mostly chronic diseases, mainly dermatological, stomach, and gynecological diseases. No matter what the disease is, doctors only open up some blood-smoothing and gas-regulating drugs. These drugs have no therapeutic effect and will not eat dead people.
Intimidation and inducement, packaging "cooperative" private hospitals into a fraud platform
The private medical institutions involved in the case are fraud platforms for Yiyi Medical Trust Fraud. According to the police, Yi and Chen’s couples used threats, intimidation and other unfair methods to force formal and legal private medical institutions to cooperate with them, and 50% of registration fees and 12% of drug costs were returned to clinics.
According to reports, in 2002, Yi Mou came to Shanghai and was introduced by the fellow villager into the medical circle. In 2004, he contracted the Department of Traditional Chinese Medicine from the South Asia Hospital of Minhang District and began hiring fellow villagers for medical care.
"After 2005, I bought a 51% stake in Shanghai Gankang outpatient clinic from a Fujianese person for a price of 370,000 yuan." Yi Yi stated that in April 2012, he purchased Shanghai again for 580,000 yuan. 80% of the shares of Shengcao Traditional Chinese Medicine Clinic.
Since then, Yiyi has separately bought 80% of Donghuqing Yutang Pharmacy, Mingyang Traditional Chinese Medicine Clinic, Fushou Clinic, 100% of Jindian Hospital, contracted the Huachin outpatient department of Traditional Chinese Medicine, and used the hospital to engage in fraud.
According to Wang Kai, deputy director of the Shanghai Pudong Public Security Bureau, these private clinics involved in the case all had normal outpatient qualifications at the very beginning, but after the Health and Planning Commission gave him medical licenses, they changed course and they would normally hire physicians. Nurses and other staff swept out.
Xia Mou, a Fushou clinic member, confessed to the police that in March 2013, a Hunan man who claimed to be “Old Yi” said that he would cooperate with him. “He said that on the one hand, my management of the clinic is too backward. If I don't cooperate with him, my clinic cannot be operated.” In the end, the two parties agreed that Yiyi will pay 800,000 yuan for the pre-payment as a subsidy, and at the same time invest in renovating the business, and the profit will be divided into two parts by Xia and Yi. As a result, an 800,000-yuan fund was not in place, and Xia Mou was denied the right to operate the clinic.
Strong concealment of behavior, it is hard to determine the nature of medical insurance fraud
Qian Naijun, chief of the three detachment of the Criminal Investigation Corps of the Shanghai Municipal Public Security Bureau, said: “Yiyi’s medical support gangs are operated in a company and have a clear hierarchy. In 2009, when the Shanghai police investigated a case of fraudulent medical care fraud, Zeng Shun’s chief was behind the scenes. After an arrest, Yi Yi was released on bail after the lack of evidence.”
It is difficult to investigate and collect evidence to make it difficult for medical trust fraud crimes to continue. “The doctor's medical behavior is very concealed.” Shan Xuewei said, “In the process of soliciting, doctors rarely directly resort to violent threats. They often use the urgency of the patient’s psychiatry to cure the disease and intentionally fabricate it in person. The medical experience and other methods make the victim 'voluntarily' go to the relevant clinic for medical treatment and pay high medical fees. Due to the different circumstances of each victim, the police are more difficult to grasp in the application of the law."
“The medical care fraud crime has affected the hospital's normal medical treatment order.” The Shanghai police said that the personnel involved in the case had obvious regional characteristics, and it was easy for them to pull in and help form an organized criminal gang, which had a negative impact on public security.
It is understood that the Shanghai police will further intensify its interrogation, improve its evidence chain, and pursue criminal investigations in accordance with law.

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