The National Healthcare Security Administration (NHSA) has released its 2023 Basic Medical Insurance (BMI) Fund Flying Inspection Plan, following a report on the impact of such efforts in hospitals during 2022. This year’s inspections will concentrate on medical imaging, clinical examination, and rehabilitation services, focusing on the use and management of the BMI fund from January 1, 2021, to December 31, 2022, with the possibility of extending the timeframes.
Random Selection Process and Targeted Inspections
The NHSA, in collaboration with relevant departments, will randomly select provinces to participate in the inspection process by drawing lots. Cities with significant fund usage, typically at the prefecture-level, will be targeted within each selected province. Two hospitals and one pharmacy will be chosen from the top-ranked designated medical institutions in terms of medical insurance payment within the inspected city, along with the municipal medical insurance agency, as the units under scrutiny. Inspections may also be directed based on reported clues and intelligent monitoring of suspicious activities. Institutions previously inspected will not be re-inspected in principle.
Scope of Inspections
For designated medical institutions, inspections will cover internal control management, financial management, implementation of drug and consumables volume-based procurement (VBP), and medical service and charging behaviors related to the use of medical insurance funds. Designated retail pharmacies will be inspected for violations such as card swiping, falsification of information, fees swapping, and settlement of medical insurance fees for non-designated institutions. Medical insurance agencies will be reviewed for daily fee review and payment processes, verification of declared fees by designated medical institutions and insured individuals, determination of annual budget limits under DRG/DIP payment methods, and the use of intelligent audit systems.
Timeline and Responsibility System
A team leader responsibility system will be implemented for the flying inspections, with the preliminary preparation work expected to be completed by July 2023. On-site inspections are scheduled for August to December 2023, followed by summary work in January to March 2024.-Fineline Info & Tech
