On October 22, a conference on the regulatory trends of the medical insurance fund in China, along with the release of a blue paper, took place in Beijing. During the event, Xie Zhangshu, deputy director of the Fund Supervision Department at the National Healthcare Security Administration, shared some significant findings about fund recovery efforts this year.
From January to September, Xie reported that medical insurance departments at all levels nationwide successfully retrieved 16.06 billion yuan (approximately $2.3 billion) from misuse of medical insurance funds. He emphasized that since its establishment, the National Healthcare Security Administration has prioritized the safety of the medical insurance fund. The agency has intensified oversight and inspection efforts, explored improved regulatory methods, and established a more robust and enduring mechanism to combat healthcare fraud.
“This year alone, we have seen remarkable progress in strengthening fund oversight,” Xie stated. “As of September, the total amount recovered from fraudulent activities increased by 38.7% compared to the previous year.”
Xie further elaborated that the National Healthcare Security Administration’s flying inspection program has now reached all provinces across the country, involving checks on 500 designated medical institutions—more than the total from the previous five years combined. In 2023, suspicious leads identified through big data analysis have significantly guided on-site inspections, enhancing the agency’s targeting abilities against fraud. “We have conducted special flying inspections based on big data models on 185 designated medical institutions, uncovering 111 instances of suspected fraud,” he revealed.
Looking ahead, Xie outlined the National Healthcare Security Administration’s commitment to expanding the scope of flying inspections, implementing thorough self-examinations, reinforcing big data monitoring, improving long-term mechanisms, and increasing the visibility of their efforts to protect the public’s medical funds, often referred to as “life-saving money.”
The conference also featured the launch of the blue paper titled “Development Report on the Supervision and Management of China’s Medical Security Fund (2023-2024),” which comprehensively reviews the progress, challenges, and future trends related to medical insurance fund supervision in China, offering actionable and forward-looking recommendations for improvement.
