China Rewarding Whistleblower On Medical Fraud

China’s National Healthcare Security Administration (NHSA) has launched a tip-off service via its official WeChat account that enables organizations and members of the public to report leads on medical insurance fraud. Under the terms of the scheme, eligible informants will be rewarded with a one-time payment ranging from ¥200 (about US$28) to ¥200,000, according to the administration.

Noting that the misuse of medical insurance funds undermines public interests, NHSA urged the whole society to make efforts in combating the problem.

The Chinese government has vowed to continue strengthening oversight of medical insurance funds to ensure every penny is maximised for the benefit of public health.

Other efforts to prevent medical insurance fraud include the development of a system to validate healthcare professionals who are able to process medical insurance funds. Elsewhere, a drug traceability code – an electronic ID – is being considered for every medication. The hope is that this will curb fraudulent activities such as the resale and substitution of medications people are taking, as well as the abuse of medical insurance cards and fake prescriptions. The problem of abuse of medication related to insurance funding is already being addressed through a scheme that encourages pharmacies to integrate with a new reimbursement system for provision of outpatient services. The scheme enables those with medical insurance to be reimbursed for the cost of their medication at these pharmacies.

The Xinhua news agency reports that in 2024, China’s medical insurance watchdogs recovered ¥27.5 billion of misused medical insurance funds, with a total of 10,741 suspects arrested.