Medical Insurance Fraud - China

China is intensifying its crackdown on organized criminal networks involved in medical insurance fraud, as they pose a serious threat to the integrity of the medical system.
Experts said that it shows a strong commitment to strengthening fund oversight and control. However, policies should be further enforced and implemented across various stages of medical regulation.

Fraudulent Gang - In a recent major crackdown, authorities seized nearly 30 tons of medication illegally obtained by a fraudulent gang. The gang paid to borrow other people's medical insurance cards or persuaded the insured to use their medical insurance card to dispense drugs in different community health centers.

In another recent crackdown, authorities confiscated 105 medical insurance cards and over 10,000 boxes of various drugs. Relevant criminals exploited the medical insurance system to purchase excessive amounts of medication, which they then sold to other merchants with higher price for profit.

Medical insurance fraud - is increasingly being committed by a diverse range of perpetrators, according to the latest data for 2021-23. Perpetrators include insured persons and their close relatives, professional insurance fraud gangs, designated medical institutions, designated retail pharmacies, and in some cases also involve drug manufacturing enterprises. Among them, insured people were involved in nearly 55 percent of the cases, accounting for more than 50 percent of the total.

It is necessary to upgrade the national medicine supply security code, which can track the medical distribution process to ensure transparency and accountability. In 2023, China's medical insurance authorities inspected 802,000 designated medical institutions and identified violations in 451,000 of them, according to a statement released by China's National Healthcare Security Administration in July.