In its fight against fraud in health insurance funds China has launched a series of measures in the recent past. In yet another move, China's National Healthcare Security Administration in April this year launched a tip-off service via its official WeChat account, enabling social organisations and the public to report leads on medical insurance fraud.
Eligible informants will be rewarded with a one-time payment ranging from CNY200 ($27.8) to CNY200,000 according to the administration.
Noting that the misuse of medical insurance funds undermines public interests, the administration has urged the whole society to make efforts in combating fraud.
In 2024, China's medical insurance watchdogs recovered CNY27.5bn of misused medical insurance funds, with a total of 10,741 suspects arrested. The NHSA in 2024 identified 2,008 fraudulent insurance institutions and worked with public security authorities to investigate 3,018 medical insurance fraud cases.
The NHSA also plans to roll out very soon stricter regulation of medical insurance funds through a nationwide implementation of drug traceability codes. This initiative intends to curb fraudulent activities such as the resale and substitution of insured medications, as well as the misuse of medical insurance cards and counterfeit prescriptions.
The drug traceability code is a unique electronic ID for each medication and, will be used to build large-scale data models to enhance regulatory oversight. The NHSA will use this data to identify and crack down on violations, strengthening enforcement actions against illegal activities.
According to industry sources it is necessary to upgrade the national medicine supply security code, which can track the medical distribution process to ensure transparency and accountability.
China had also announced developing a points-based credit system for healthcare professionals who are certified to process medical insurance funds to curb the misuse of funds and strengthen punishment for violators.
A scheme to encourage drugstores nationwide to integrate with the reimbursement system for outpatient services under the country's medical insurance schemes has already been implemented and this enables those covered by medical insurance schemes to have their purchases of medicine at drugstores reimbursed by medical insurance funds.