China’s National Healthcare Security Administration has introduced an online whistleblower platform to encourage the public to report medical insurance fraud, aiming to enhance the security of healthcare funds. This initiative, announced on Monday, allows individuals to report fraud through the administration’s official WeChat account, with whistleblowers eligible for one-time rewards ranging from 200 yuan ($27.3) to 200,000 yuan, depending on the value of the information provided.
The platform is part of China’s ongoing commitment to combat medical insurance fraud, with a zero-tolerance policy in place. In 2023, the administration recovered 27.5 billion yuan in misused insurance funds and uncovered 2,008 fraudulent agencies. Gu Rong, head of the administration’s fund supervision department, revealed that authorities worked with public security agencies to investigate 3,018 medical insurance cases, leading to the arrest of 10,741 individuals.
“The crackdown on fraudulent practices has led to the termination or suspension of insurance agreements for several agencies, and some have been referred to public security and disciplinary bodies for further investigation,” Gu said during a press conference in January.
To improve fraud detection, the administration has implemented big data supervision models, including systems to identify abnormal hospitalization records and the resale of insurance-covered drugs. These models have helped recover nearly 600 million yuan in misused funds.
Further measures include the introduction of drug traceability codes—unique electronic tags for each medication—to prevent fraud involving the resale or substitution of insured drugs. Additionally, a credit system for hospital and pharmacy personnel authorized to process insurance funds has been established to tighten oversight.
In November, the administration recognized whistleblowers for the first time, rewarding six individuals from Beijing, Xizang, Jiangsu, Guangdong, Heilongjiang, and Zhejiang a total of 721,400 yuan for their contributions.
One high-profile fraud case was exposed in September after a local doctor in Wuxi, Jiangsu, alerted the media. The case involved Wuxi Hongqiao Hospital, where authorities discovered the hospital had fraudulently misused 22.3 million yuan, including 11.79 million yuan obtained through fabricated medical records and manipulated hospitalization claims. In response, the hospital was fined 58.96 million yuan, and its operating license was revoked.
This new whistleblower platform is seen as a significant step in China’s effort to safeguard the integrity of its medical insurance system, reinforcing the country’s determination to fight fraud and protect public funds.
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