By Fineline Cube 
On September 7, 2025, China’s National Healthcare Security Administration (NHSA) issued the Draft Implementation Rules for the Supervision and Administration Regulations on the Use of Medical Insurance Funds. The draft, comprising five chapters and 57 detailed rules, invites public commentary until October 7, 2025.
Key Provisions
| Section | Focus | Impact |
|---|---|---|
| Self‑Management of Institutions | Designated medical and pharmaceutical providers must strengthen internal controls, conduct regular self‑examinations, and upgrade IT infrastructure. | Reduces operational risk and improves data transparency. |
| Agency‑Provider Agreements | Medical insurance agencies must formalize service contracts, enforce agreement obligations, and implement robust management oversight. | Enhances accountability and aligns incentives. |
| Payment Compliance | All medical insurance fund disbursements must adhere to national standards. The draft bans practices such as split stays, fake hospitalizations, excessive treatment, and duplicate billing. | Curtails fraud and protects fund integrity. |
| Legal and Administrative Sanctions | Violations—including false identities, fabricated service items, and drug resale—will trigger legal liabilities and administrative penalties. | Deters non‑compliance and protects public resources. |
Enforcement Measures
- Regular Audits – Mandatory periodic reviews of designated institutions.
- Real‑Time Reporting – Mandatory IT systems for instant claim and service data transmission.
- Penalties – Graduated fines, license revocation, and criminal prosecution for severe infractions.
Industry Impact
- Operational Costs – Institutions must invest in IT upgrades and compliance training.
- Transparency – Greater data visibility may improve patient trust and insurer confidence.
- Market Dynamics – Stricter controls could consolidate market share among well‑resourced providers.
Conclusion
The NHSA’s draft rules signal a decisive push to safeguard medical insurance funds, eliminate fraud, and reinforce the integrity of China’s healthcare financing system. Stakeholders are urged to review the draft carefully and submit comments before the October 7, 2025 deadline.-Fineline Info & Tech