SCIO press conference on implementing major decisions of 20th CPC National Congress, promoting high-quality development of healthcare security
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E-mail China.org.cn, June 6, 2023
Beijing Youth Daily:
We understand the safe and stable operation of medical insurance funds is directly linked to the vital interests of every insured individual. My question is, what measures have you taken, since 2018, to combat insurance fraud? What follow-up measures will be taken to protect the money that people rely on to pay their medical bills? Thank you.
Hu Jinglin:
Thank you for raising this crucial question. Medical insurance funds are vital in providing financial support for healthcare expenses. The NHSA has been diligently implementing Comrade Xi's instructions and considers the supervision and protection of medical insurance funds our top priority. We have taken strong actions to combat any fraudulent or unlawful use of these funds, ensuring that they do not become a source of misuse or exploitation.
After five years of efforts, we have employed a comprehensive approach, combining multiple strategies, to establish a stringent oversight system for medical insurance funds.
First, we have carried out flight checks in a targeted manner to uncover illegal and non-compliant behaviors. We have adopted the mechanism of "no prior notification, top-down and cross-checking," which addressed the issue of ineffective oversight at the same level due to familiarity among parties. As a result, we have struck a heavy blow to unlawful and non-compliant behaviors, showcasing the role of flight checks as an effective tool. Additionally, we have encouraged designated medical institutions to learn from their mistakes and conduct self-examination to prevent similar illegal and non-compliant behaviors. Medical institutions that take the initiative to conduct self-examinations will be given leniency in terms of inspection frequency and punishment. This is in line with the law enforcement philosophy of balancing punishment and clemency. Since 2019, the NHSA has deployed 184 flight check teams, inspecting 384 designated medical institutions. The inspections have uncovered suspected illegal and non-compliant use of medical insurance funds totaling 4.35 billion yuan.
Second, we have launched special campaigns to address malpractices in crucial areas. Medical insurance departments, in cooperation with health and public security authorities, have focused on key fields such as orthopedics, hemodialysis, and cardiology. They have also tackled significant issues like the use of essential drugs and medical supplies, fake medical record, and the resale of medicines covered by the national medical insurance system for profit. These targeted oversight and inspection efforts have eliminated the root causes that threaten people's "life-saving money." In 2022 alone, officials cracked 2,682 cases and arrested 7,261 suspects. A total of 1.07 billion yuan of improperly used medical funds have been retrieved.
Third, we have conducted daily oversight with the help of data-based technologies. By fully utilizing modern information technologies such as intelligent monitoring and big data, we have accelerated our efforts to establish a comprehensive, tiered, and multifaceted regulatory system. In 2022, we denied payment of and recovered 3.85 billion yuan through intelligent monitoring, accounting for about 26% of the total amount recovered. With the help of a big data model for false hospitalization, we have been able to identify crime clues precisely. As a result, nearly 500 people were arrested and 100 million yuan was investigated.
Next, we will continue to strengthen flight checks and carry out special campaigns to crack down on medical insurance fraud. Efforts will be made to investigate a number of significant cases, knock out a number of major gangs, and publicly expose a number of typical cases. These will help to maintain a tough stance against medical insurance fraud, ensuring that no one dares to cheat. We will strengthen big data regulations and build a network for public supervision, leaving no opportunities for anyone to cheat. We will also improve policies such as global budget and allowing medical institutions to keep the surplus of allocated funds as encouragement for use of drugs centrally procured. Efforts will be made to guide designated medical institutions and designated retail pharmacies, as well as medical personnel, to regulate their behaviors, thus pushing for the establishment of a long-term mechanism that prevents the intention of committing fraud. Thank you!
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