Since its establishment in 2018, China’s National Healthcare Security Administration (NHSA) has intensified oversight of the medical insurance fund and cracked down on fraud and abuse. By 2023, over a five-year period, the NHSA had recovered approximately RMB 120 billion in misused funds, effectively safeguarding the public’s essential healthcare resources—often referred to as ‘money for treatment’ or ‘lifesaving funds.’ This achievement stems from a multi-pronged regulatory approach: leveraging big data and artificial intelligence to enhance intelligent monitoring and accurately detect abnormal medical practices; conducting frequent, nationwide surprise inspections and targeted enforcement campaigns to deter misconduct by hospitals, pharmacies, and insured individuals; and implementing whistleblower reward programs to encourage public oversight. Additionally, the NHSA is accelerating legislation to strengthen the legal framework for fund supervision. The recovered funds have alleviated financial pressure on the insurance system and bolstered public confidence in China’s healthcare security mechanism. Going forward, continued improvements in regulatory systems will ensure that the medical insurance fund operates more securely and efficiently to support universal health coverage.
国家医保局自2018年成立以来，持续强化医保基金监管，严厉打击欺诈骗保行为。截至2023年，五年间共追回医保基金约1200亿元，有效守护了人民群众的‘看病钱’‘救命钱’。这一成果得益于多措并举的监管体系：一方面，通过大数据、人工智能等技术手段提升智能监控能力，实现对异常诊疗行为的精准识别；另一方面，开展高频次、全覆盖的飞行检查和专项整治行动，对医疗机构、药店及参保人员的违规行为形成高压震慑。此外，国家医保局还推动建立举报奖励机制，鼓励社会监督，并加快医保基金监管立法进程，为基金安全提供制度保障。追回资金不仅缓解了医保基金运行压力，也提升了公众对医保制度的信任度。未来，随着监管体系不断完善，医保基金将更加安全、高效地服务于全民健康保障。
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