The National Healthcare Security Administration (NHSA) is intensifying efforts to manage medical insurance funds at hospitals by launching a crackdown. The agency has released the “Interim and Management Measures for Unannounced Inspections of Medical Security Funds,” which will be effective as of May 1, 2023.
Details of the Measures
The document outlines the conditions under which inspections will be conducted, the methods to be used, inspection requirements, and procedures. These unannounced inspections are organized by national and provincial medical insurance bureaus and target designated medical institutions, medical insurance agency institutions, and other entities operating within the Basic Medical Insurance (BMI) system.
Triggers for Inspections
Unannounced inspections can be scheduled in response to reports of excessive spending, triggered by smart monitoring or big data screening of safety risks, media exposes, or other factors. This proactive approach aims to enhance the integrity and efficiency of medical insurance fund management.
Previous Efforts and Results
Since 2019, the NHSA has deployed 184 unannounced inspection teams, affecting 384 designated medical institutions and uncovering RMB 4.35 billion (USD 631.4 million) in illegal fund misuse. In 2022 alone, 2,756 designated medical institutions underwent unannounced inspections, resulting in the recovery of RMB 2.29 billion (USD 332.4 million) in BMI funds.
Significance of the Initiative
This initiative underscores the NHSA’s commitment to ensuring the proper use of medical insurance funds and preventing misuse. By implementing these measures, the agency aims to improve the overall management of medical insurance funds and enhance the effectiveness of the healthcare system.-Fineline Info & Tech
