Kathmandu. China’s National Health Service Security Administration (NHSA) has implemented new rules to address growing concerns about medical insurance fraud.
The new rules, titled “Implementing Regulations on the Supervision of the Use of Medical Insurance Funds,” aim to monitor and combat fraudulent practices in China’s healthcare sector. The announcement marks the official start of a nationwide campaign targeting illegal activities in the medical insurance and pharmaceutical sectors.
The first phase of the campaign will run until July 2026. It will focus on identifying and eliminating fraudulent practices in hospitals, clinics, pharmacies and other medical institutions.
According to the NHSA, the new rules provide a more detailed framework to fight the misuse of medical insurance funds and to specify practices that are considered fraudulent. These include falsifying medical records, promoting treatments and medicines through false advertisements, and encouraging patients to seek treatment under false identities.
The new rules explicitly prohibit the resale of insured drugs, counterfeiting medical records, and offering unfair incentives or fee waivers to patients for unnecessary treatment. Organizations found guilty of these practices will face heavy administrative penalties, and those who knowingly participate in such schemes will face criminal charges.
Article 41 is a key component of China’s new rules. It mandates criminal recommendations for serious violations. This article ensures that cases that reach the criminal threshold will be transferred directly to legal entities for prosecution. The move is expected to strengthen accountability and help deter future criminals.
The primary objective of this action is to protect China’s basic medical insurance fund. It covers about 95 percent of the population.
As China’s population ages, and the demand for health services grows, the Chinese government is facing increasing pressure to ensure proper use of public health care funds. Previous efforts to fight fraud have recovered billions of yuan of misused funds. But the new regulatory framework aims to bring operational clarity and increase coordination among multiple government agencies. “With this initiative, we aim to increase the security of healthcare funds and ensure that they are used for the benefit of our citizens,” said Liang Zhao, a senior NHSA official. ’
The first phase of the nationwide campaign, which began on April 1, will focus on early detection and resolution of fraudulent activities. Officials have pledged rigorous audits of hospitals, clinics and pharmacies. That includes unannounced inspections.
The second phase, which will run from September to November, will include heavier fines, suspension of business licenses and possible criminal prosecution. Organizations that violate the rules will have to pay compensation and can be banned from working in the medical and pharmaceutical fields for a long time. –Agency
