NHSA Tightens Regulation of Healthcare Security Funds and Resolutely Combats Medical Insurance Swindles and Fraud

The National Healthcare Security Administration ("NHSA") has recently issued the Circular on Maintaining Effective Regulation of Healthcare Security Funds in 2019 (the "Circular").

The Circular sets out arrangements in ten aspects which include "stepping up efforts in the crackdown and maintaining a tough stance" and "improving the reporting system and standardizing procedures for handling clues and investigations". According to the Circular, a special rectification program will be launched this year to fight against medical insurance fraud and swindles, and each province is required to determine one or two key aspects of this rectification program, in consideration of local actualities and aimed at addressing the inadequacies, and to concentrate their efforts on severely cracking down on such fraud and swindles. In addition, the Circular states that, in the light of characteristics of violations extensively or frequently committed by different groups of targets, efforts shall be focused on priorities to clamp down various violations in a differentiated manner and take targeted measures. For medical institutions designated under the medical insurance scheme, authorities need to determine the key regulatory aspects, according to the characteristics of their services, and focus efforts on looking into and eliminating violations, including breaking down fee items, charging fees higher than the fee standard, duplicating charges, charging fees in the name of other fee items, charging fees for unreasonable diagnosis and treatment, among public medical institutions at or above Grade 2. Furthermore, the Circular calls for efforts, in combination with the pilot program on building a credit system, to explore the establishment of a "blacklist" system for designated medical institutions, physicians familiar with medical insurance policies and medication and the insured individuals with serious violations.



(Source: http://www.nhsa.gov.cn/art/2019/2/26/art_37_934.html)

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