context: The NHSA (National Healthcare Security Administration), established in 2018, has recovered a total of C¥83.5 bn in healthcare insurance funds. In the first half of this year, healthcare insurance authorities nationwide inspected 390,000 designated medical institutions, taking action against 160,000 entities found in violation and recovering C¥63.4 bn in related funds.
NHSA (National Healthcare Security Administration) officials are focusing on employing a combination of measures to crack down on various illegal and improper uses of healthcare insurance funds. Key initiatives to ensure the security of healthcare insurance funds, according to Gu Rong 顾荣 NHSA Fund Supervision Department deputy director, include
- regular unannounced inspections
- launching national unannounced inspection operations in August
- focusing on medical imaging, patient care and rehab
- including retail pharmacies
- targeted reforms in key areas
- cooperated with other departments including police and financial agencies in 2023
- key drug and consumable items with high settlement costs in healthcare insurance
- using big data analysis
- selected 11 provinces, regions, municipalities and 53 integrated healthcare insurance regions for a pilot project using big data to combat healthcare insurance fraud
- continuing to oversee public reports
- establishing long-term mechanisms
- reforming cross-regional outpatient care payment methods
- drafting detailed rules for the supervision and management of medical security fund use
Gu promises NHSA will continue to intensify its supervision of healthcare insurance funds, building a comprehensive, multi-level and three-dimensional system for healthcare insurance fund management.