China has launched a nationwide crackdown on medical insurance fraud, with a particular focus on mental health institutions and the over-prescription of high-cost medications. This initiative aims to curb illicit practices and ensure the integrity of the national healthcare system.
Authorities are intensifying oversight of designated mental health institutions across China. Following media reports of some hospitals in Hubei province offering free services to attract patients, the National Healthcare Security Administration (NHSA) has directed provincial departments to strengthen management and eliminate the illegal use of insurance funds. Institutions are required to conduct self-inspections and rectify any identified problems, with reports due to the NHSA by the end of March. This move signals a commitment to ensuring compliant and ethical practices within the mental health sector.
The NHSA is also shifting its anti-fraud focus towards hospitals by cracking down on the over-prescription of 50 high-cost medications. This strategy aims to prevent the illegal resale of subsidized drugs. Pilot regions are incorporating at least 50 key drugs into their monitoring systems, with plans to expand nationwide to cover 100 drug types by June 2026. Unified national regulatory rules are expected by the end of that year. The initial focus is on treatments for chronic diseases like hypertension, diabetes, and kidney disease, including specific drugs such as Amlodipine benzenesulfonate tablets and Metformin hydrochloride tablets.
Representative cases highlighted by the Supreme People’s Court reveal the multifaceted nature of medical insurance fraud. These include systemic fraud within medical institutions, such as fabricating hospitalizations and inflating drug prices, leading to severe penalties like 13.5-year prison sentences. Downstream criminal networks involved in the illicit resale of insurance-funded drugs via digital channels are also being targeted. Furthermore, individual and collusive fraud, such as exploiting benefits for unnecessary medications, is under scrutiny. The enforcement strategy emphasizes “full-chain accountability,” document integrity, and judicial coordination, reflecting a sustained regulatory commitment to safeguarding public healthcare funds.