A nursing home medical clinic in Shanghai was fined over 120,000 yuan for providing fictitious medical services for insurance fraud.

On the 17th, the Shanghai Medical Insurance Bureau released a case of a nursing home medical room committing insurance fraud and being administratively penalized, involving more than 120,000 yuan of medical insurance funds. According to the announcement, the institution involved is the medical room of the Yangpu branch of a Shanghai elderly care service limited company, which is a designated medical institution for Shanghai medical insurance. In September 2025, the local medical insurance department discovered during a routine risk assessment of newly enrolled designated medical institutions that the settlement frequency of traditional Chinese medicine treatment projects in the medical room was significantly higher than the average level of similar nursing homes. Furthermore, there was an abnormal situation where different elderly people were diagnosed with different diseases but were prescribed highly consistent treatment projects. The workload of traditional Chinese medicine treatment exceeded the reasonable carrying capacity of the traditional Chinese medicine physicians and assistant physicians assigned to the medical room. In response to the above suspicions, the medical insurance department immediately launched a special investigation. Through comprehensive review of medical records, item-by-item inventory of traditional Chinese medicine diagnosis and treatment consumables, questioning of relevant medical staff, retrieval of surveillance videos, and visits to over a hundred elderly patients in the nursing home, evidence was collected from multiple sources, cross-verified, and traced back along the entire chain of evidence. It was confirmed that from March 1, 2024 to February 28, 2025, the medical room had committed fraud by implementing fake treatment projects such as fake ear acupuncture pellets and buried needle points through forging medical records, defrauding more than 120,000 yuan of medical insurance funds.