Pharmacist jailed for falsifying test results, insurance fraud

A pharmaceutical representative has been sentenced to eight months in prison for falsifying patients' medical test reports to secure unnecessary prescriptions of anticancer drugs and defraud the medical insurance fund, according to a notice released by the National Healthcare Security Administration on Wednesday.

To meet his personal sales target for Osimertinib — a drug used to treat non-small cell lung cancer with a specific genetic mutation — the representative, surnamed Lu, altered the genetic test results of patients who did not meet the treatment criteria.

Based on the falsified reports, respiratory physicians prescribed the drug to three patients — one in October 2020 and the others between January and April 2021 — resulting in a loss of 27,540 yuan ($3,870) to the medical insurance fund.

Lu was convicted of fraud and sentenced to eight months in prison, along with a fine of 7,000 yuan. Recovered illicit proceeds have been ordered to be returned to the medical insurance fund, the administration said, citing a recently published court verdict.

The administration emphasized that the use of such targeted drugs must strictly follow the indications and usage conditions specified in the drug instructions. Improper use not only fails to achieve therapeutic effects, but also poses safety risks, delays appropriate treatment, wastes medical insurance resources, and increases the financial burden on patients.

"This case serves as a stern legal warning that red lines must not be crossed, and bottom lines must not be breached," the administration said.