国家医保局通过药品追溯码大数据监管平台，侦破一起涉案金额超4000万元的跨省倒卖药品案件1。该犯罪团伙通过超量开药、层层加价倒卖等手段，将11000多盒药品经网络平台销往全国25个省市1，涉及70余个统筹区、150余家定点医疗机构1，造成医保基金大量损失。犯罪嫌疑人非法获利数百万元1。
2025年以来，全国医保部门加大监管力度，已查处违法违规机构6.2万家，联合公安部门破获案件近千起，涉案金额超30亿元1。在重点监测的320种易倒卖回流药品中，支出减少了约450亿元1。国家医保局累计下发近200万条核查线索1，推动99%的定点医药机构实现了扫码上传1。目前，国家医保服务平台App日均查询量已超500万人次1，为防范医保基金风险提供了有力支撑。
The National Medical Insurance Bureau has cracked a significant cross-provincial drug diversion case worth more than 40 million yuan by leveraging its drug traceability code big data monitoring platform 1. The criminal network illegally obtained excessive quantities of pharmaceuticals and resold them through online channels to over 25 provinces, municipalities, and autonomous regions across more than 70 coordinating areas and 150-plus designated medical institutions, resulting in substantial losses to the medical insurance fund 1. Investigators recovered more than 11,000 boxes of the diverted medications 1.
The scheme involved multiple layers of markup resales, with suspects generating illicit profits in the millions 1. Since 2025, medical insurance authorities nationwide have taken action against 62,000 institutions for violations and irregularities, working with public security departments to solve nearly 1,000 criminal cases with total losses exceeding 3 billion yuan 1. Among 320 priority-monitored pharmaceutical products prone to diversion, expenditures have decreased by approximately 450 billion yuan 1. The National Medical Insurance Bureau has issued close to 2 million verification leads in response to the scheme 1, while the National Medical Insurance Service Platform App now records over 5 million daily inquiries 1. Notably, 99 percent of designated medical and pharmaceutical institutions have achieved code-scanning upload compliance 1.
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