The key task for the medical insurance bureau to set up the punishment system of dishonesty

Drug rebate has long been a "cancer" in the pharmaceutical industry It is always the top priority of policy to drive up drug prices, stimulate drug abuse, waste medical insurance funds and damage the interests of patients The state health insurance bureau will establish a credit evaluation system and a punishment system for dishonesty, and link drug rebate with illegal punishment, drug bidding and purchase, and drug price On December 6, a seminar led by the state health insurance bureau was held in Beijing, attended by the Department of drug administration of the state health and Health Commission, the price bidding Department of the state health insurance bureau and other government departments, China Pharmaceutical Association, China Pharmaceutical Business Association, China Chemical Pharmaceutical Industry Association and a number of experts in the legal, economic, medical and other professional fields In fact, there is only one topic to be discussed, that is, how to solve the problem of drug rebate and cash sales that have been hard to return in the field of pharmaceutical purchase and sale for a long time? Drug rebate has long been a "cancer" in the pharmaceutical industry It is always the top priority of policy to drive up drug prices, stimulate drug abuse, waste medical insurance funds and damage the interests of patients But at the same time, there are many disciplinary measures for drug rebate issued by various departments before, but there are still problems of fragmentation and self governance After the reform of "replacing business tax with value-added tax", a large number of contract sales organizations (CSOs) appeared in the industry, and the production enterprises used CSOs to avoid the legal risk of rebate In view of the above problems, the State Health Insurance Bureau commissioned Beijing University to carry out relevant research, and through the construction plan of two parts of the credit evaluation system and the dishonesty punishment system, the drug rebate was associated with the illegal punishment, drug bidding and purchase, and drug price The specific implementation will use the open source of cases to evaluate the credit of enterprises After the establishment of the evaluation system, the medical enterprises will be given graded punishment by using the evaluation results At the beginning of this credit evaluation system and credit failure punishment system, it is mainly aimed at the procurement bid winning enterprises, which will be expanded in a larger scope in the future Through the investigation of the source of the violation of discipline and law, a unified credit evaluation system for the production enterprises is established, so as to achieve the punishment for the enterprises that are dishonest The ultimate goal of the study is to build a credit evaluation system for the production enterprises According to the results of the above-mentioned credit evaluation, a graded punishment plan for dishonest production enterprises within the framework of the contract law is established, including but not limited to regional price reduction, national price reduction, regional temporary prohibition, national temporary prohibition and national permanent prohibition The research mainly covers three parts First, to investigate the dishonesty in the centralized purchase of drugs in public hospitals Secondly, taking the judgment documents of the people's courts at all levels as the source of the case, taking the sales with gold as the main dishonest behavior, combining the opinions of experts and representatives of stakeholders, adopting the method of grading and weighting, to build the credit evaluation index system of production enterprises Third, build a system of punishment for dishonesty Based on the above evaluation results, design a graded punishment scheme for dishonesty and demonstrate its rationality, legitimacy and feasibility The research results will be based on the investigation report on the dishonesty in the process of drug purchase in public hospitals, the credit evaluation method for the winning enterprises in the centralized purchase of drugs in public hospitals, the punishment method for the winning enterprises in the centralized purchase of drugs in public hospitals, the letter of credit commitment for the winning enterprises in the centralized purchase of drugs in public hospitals and the template of credit terms in the centralized purchase and sale contract of drugs in public hospitals 》It is expected that the scheme design, simulation and demonstration will be completed by the end of January 2020 The model of credit system and punishment system consists of three parts: information collection and processing, credit evaluation and credit result application The information collection and processing will mainly come from the information of judgment documents, discipline inspection and supervision, and market supervision According to the new drug administration law, the illegal discipline of CSO will be included in the credit score of the manufacturer The application of credit results will be publicized and punished according to the previously collected information The punishment methods will be implemented in various forms, such as influencing the bid evaluation score, reducing the purchase price, paying liquidated damages and banning some or all of them Six out of 100 bribery cases involve drug companies in China, which is not low, according to the official document network How to establish an evaluation system for pharmaceutical enterprises based on these dishonest behaviors, and then establish a disciplinary system, has become a thorny problem in front of us According to the new drug administration law and the relevant provisions on kickback punishment, "according to the market supervision and administration department, the illegal income shall be confiscated and a fine of more than 300000 yuan but less than 3 million yuan shall be imposed If the circumstances are serious, the holder of the drug listing license and the business license shall be revoked The bribery of state functionaries shall be prohibited from engaging in drug production and marketing activities for life to the legal representative, the main person in charge, the person in charge directly responsible and other persons in charge " However, for large pharmaceutical companies with incomes of over 100 million, they will choose to take risks in the face of fines At the same time, the data shows that only one of the six cases mentioned the treatment of bribery For drug kickbacks, law enforcement agencies, including discipline inspection departments, mainly targeted at bribery, while the treatment of bribery was relatively light In 2018, there were more than 300 presidents who were publicly dealt with Up to now, no major person in charge of the production enterprise has been punished What can be found is the regional pharmaceutical representative or the regional commercial company Apart from the GSK case, no production enterprise has been judicially dealt with due to bribery In the main laws of the United States on drug kickbacks, the anti overseas bribery law is an important part In the information of some punished pharmaceutical companies published on the SEC Website, foreign companies bribe in China, and the penalties imposed by the securities and Exchange Commission of the United States are often tens of millions Such cases include Pfizer, Novartis, AstraZeneca, GlaxoSmithKline and other major international pharmaceutical companies at least More than ten But in recent years, only GSK has been involved in bribery cases of pharmaceutical companies in China Foreign companies' violations in China are more restrained than other enterprises, and project researchers point out the seriousness of such problems in China So how does America do it? First, using the whistleblower system, the whistleblower will be rewarded with 10-30% of the fine Another method is telecommunication transaction monitoring If you get the evidence, you will talk with the enterprise, and finally reach a settlement with the enterprise, and issue an announcement to pay the fine The researchers also pointed out that the cost of such law enforcement means is very low, which is worth learning There are corresponding laws and regulations in each link of the existing punishment methods for drug kickbacks, which are participated by multiple departments In the process of sales and doctors, there are discipline inspection and judicial departments to carry out judicial punishment Centralized procurement is aimed at hospitals and pharmaceutical enterprises to reduce the price Tax inspection is the most effective means The third phase of the Golden Tax Project, including the definition of invoices, truly achieves the integration of three flows and four flows, and the rebate behavior cannot be missed in strict tax supervision and implementation At the same time, for CSO and financial supervision, the quota has been reduced from 50000 to 15000, and the people's Bank of China has to report to the people's Bank of China if the amount of public transfer to private transfer exceeds 150000, so the money is well documented For the concept of the system, it will establish a credit mutual evaluation system between enterprises and medical institutions, similar to the evaluation system of shop business websites After the establishment of the current medical insurance information system, the conditions for establishing a dynamic and real-time mutual evaluation system are more and more mature, including not only the rebate content, but also the timeliness of payment settlement, distribution timeliness, drug quality and other issues Evaluation is not only to evaluate industrial and commercial enterprises, but also to evaluate medical institutions According to this idea, it will also include standard items such as mutual certification, system self-evaluation, third-party evaluation, self repair, audit repair, etc Take the example of automatic repair, the credit score reduction caused by the dishonest behavior in the current month will gradually reply over time.