China Review News:

Recently, the NHSA has exposed many cases involving medical insurance fraud. How will health care security departments tighten oversight of medical insurance funds and protect the medical insurance coffers? Thank you.

Yan Qinghui:

Thank you for your question. Since the 18th CPC National Congress, the CPC Central Committee with Comrade Xi Jinping at its core has attached great importance to the supervision of medical insurance funds, and issued a series of decisions and plans. The third plenary session of the 20th CPC Central Committee also proposed tightening oversight of medical insurance funds. Since the start of this year, the NHSA has focused its efforts in three areas:

First, we have carried out strict inspections and severe crackdowns. We have stepped up efforts in conducting checks, including regular annual checks that are publicly announced, as well as special checks that start without prior notice or announcement, forgo any form of work report, escort or official hospitality, and go directly to the site at the community level. So far, we have inspected 432 designated medical institutions in 30 provinces. By the end of this year, the number is expected to exceed the total of the previous five years, greatly expanding inspection coverage. Localities have intensified efforts in cracking down on medical insurance fraud. A number of institutions suspected of wrongdoing were forced to terminate contracts and were transferred to the public security department. Compared with previous years, we have paid more attention this year to the role of big data technology. So far, we have identified and recovered nearly 60 million yuan of medical insurance funds through big-data screening involving "glycated hemoglobin." Another nearly 14 million yuan has been recovered through big data screening involving "diagnosis, treatments, examinations and drug use restricted to one gender." Through these efforts, we have realized a targeted crackdown based on the integration of on-site inspections and big data technology.

Second, we stay committed to maintaining a balance between leniency and strictness. We've effectively utilized self-examination and self-correction. Before the NHSA's unannounced inspections began, we organized designated medical institutions nationwide to conduct self-examinations and corrections based on a checklist of issues. This has encouraged medical institutions to more consciously regulate their services. To date, designated medical institutions at various levels have returned approximately 3 billion yuan in medical insurance funds. We've also effectively used guidance interviews, meeting with non-compliant pharmacies to urge rectification, and publicly reported these issues so that designated pharmacies could better regulate their practices. Additionally, we've leveraged public exposure. The NHSA's official WeChat account has exposed fraudulent practices by some medical institutions, including illegal and irregular activities such as excessive glycated hemoglobin testing and confusion of gender-specific examinations. This approach has strengthened the deterrent effect.

Third, we stay committed to addressing both symptoms and root causes. We're exploring a management system for medical insurance payment qualifications, using a points deduction system similar to that for driving licenses to hold responsible parties accountable. This aims to warn and educate medical personnel to consciously follow treatment norms and self-regulate their prescribing practices. We're improving the social supervision mechanism for medical insurance funds to better engage all sectors in fund supervision. Guidelines for this are currently open for public comment. We've also improved the whistleblower reward mechanism. Since 2022, a total of 2,422 rewards have been issued nationwide, totaling 3.68 million yuan, including rewards of over 100,000 yuan for three individuals and rewards of 50,000 to 100,000 yuan for eight individuals. We hope the media present here can help promote and guide society-wide participation in this reporting and reward system.

Moving forward, we will earnestly implement the decisions and arrangements of the CPC Central Committee and the State Council, and resolutely shoulder the political responsibility of safeguarding the security of medical insurance funds. We will never allow the public's money for medical treatment or life-saving care to become easy targets for exploitation. Thank you.