The National Healthcare Security Administration, Supreme People’s Procurator, Ministry of Public Security, Ministry of Finance, and National Health Commission have collaboratively released a special rectification work plan aimed at combating fraud and deception in the medical insurance field in China. This initiative underscores the government’s commitment to safeguarding the integrity of the medical insurance system and protecting the interests of policyholders.
Campaign Focus Areas and Targets
The campaign will concentrate on key areas such as orthopedics, blood purification, cardiovascular medicine, examination, testing, rehabilitation therapy, and other significant sectors within the medical insurance landscape. It will specifically target key drugs, medical consumables, and activities including seeking medical treatment for non-medical purposes and the reselling of drugs on the National Reimbursement Drug List (NRDL).
Advanced Data Models to Screen Leads
Leads will be screened using advanced data models like “false hospitalization,” “medical insurance drug reselling,” and “monitoring and analysis of key drugs.” These models will be instrumental in identifying and verifying fraudulent activities, with the information being distributed across various regions for further investigation and action.
Provincial Medical Insurance Departments’ Role in the Campaign
Provincial medical insurance departments are directed to promptly assess the progress of the special rectification efforts, analyze typical cases, and strengthen the summarization of experiences. They are also responsible for timely reporting in accordance with the work arrangements. Additionally, a quarterly statistical table detailing the work status of the medical insurance fund will be maintained, with a comprehensive summary and report of the campaign to be submitted by December 2023.-Fineline Info & Tech
