Recently, the National Healthcare Security Administration (NHSA) and five other authorities have jointly issued the Special Campaign Plan for Rectifying Illegal and Irregular Issues in the Medical Insurance Fund in 2024 (the "Plan").
The Plan outlines guidelines, key tasks, division of responsibilities among authorities, measures, and requirements for this special campaign. It emphasizes several key aspects: firstly, adhering to a problem-oriented approach and highlighting priority areas for rectification; secondly, maintaining a balance between leniency and severity, and categorizing issues for handling in accordance with the law; thirdly, upholding fundamental principle while breaking new ground, and strengthening data empowerment; fourthly, fostering inter-departmental cooperation to leverage regulatory impact; and fifthly, implementing a holistic approach addressing both symptoms and root causes and improving long-term mechanisms. The Plan aims to (1) crack down severely on fraudulent and criminal insurance violations such as false diagnosis and treatment, fraudulent drug purchases, and illegal sale of drugs covered by medical insurance; (2) dynamically monitor fund usage and investigate fraudulent acts, particularly focusing on key drugs and consumables using large amounts of medical insurance fund and exhibiting abnormal changes; and (3) conduct comprehensive self-inspection and self-correction actions in key fields such as orthopedics and hemodialysis.