China Cracks Down on Medical Insurance Fraud with Drug Traceability Codes

China's National Healthcare Security Administration (NHSA) is taking a firm stance against medical insurance fraud with the nationwide implementation of drug traceability codes. This initiative aims to combat illegal activities such as the resale and substitution of insured medications, misuse of medical insurance cards, and counterfeit prescriptions.

The drug traceability code, a unique electronic ID assigned to each medication, will be used to build comprehensive data models for enhanced regulatory oversight. This data will empower the NHSA to identify and crack down on violations, strengthening enforcement actions against illegal activities.

The NHSA has already taken significant steps towards this goal. In April 2024, a nationwide pilot program for collecting and using traceability codes was launched. In November 2024, the NHSA questioned 46 designated medical institutions about duplicate claims associated with these codes, marking the first step towards regulating medical insurance funds through traceability technology.

Furthermore, the NHSA has engaged with over 100 pharmaceutical companies to guide self-inspection, address potential violations, and clarify regulations. Local health authorities have also organized similar outreach activities.

The NHSA urges all medical institutions to strictly adhere to regulations, conduct self-checks, and report any violations to local authorities. This includes avoiding "empty billing," ensuring ethical procurement practices, and refraining from dealing in illegally sourced drugs.

By implementing these measures, the NHSA aims to ensure the proper use of medical insurance funds and protect the health and well-being of Chinese citizens.