China’s medical insurance fund management ushered in major changes and safeguarded the vital interests of every insured person.

CCTV News:In March this year, the National Health Insurance Bureau promulgated the Interim Measures for the Administration of Flight Inspection of Medical Insurance Funds, which will be officially implemented on May 1. The Measures stipulate the starting conditions, inspection procedures and problem handling of flight inspection.

The flight inspection of medical insurance fund refers to the on-site supervision and inspection organized and implemented by the national and provincial medical insurance administrative departments, without informing the inspected objects such as designated medical institutions, medical insurance agencies and other institutions undertaking medical insurance business in advance.

　　　　　　 The "Measures" further clarified the starting conditions for flight inspection. The annual work plan and reporting clues, intelligent monitoring of medical insurance or big data screening analysis, news media exposure and other factors that reflect the major security risks of the fund can trigger flight inspection, highlighting the characteristics of focusing on key areas, key issues and key objects in flight inspection and focusing on solving typical, intractable, complex and regional problems in the medical insurance field, which is helpful for medical insurance departments to actively find problems and crack down on fraudulent insurance practices.

Multi-sectoral linkage forms a comprehensive regulatory force.

The flight inspection of medical insurance fund has a high degree of specialization, involving many departments. The Measures standardize the organization and implementation details of flight inspection, clarify the staffing of flight inspection and flight inspection team organized by medical insurance departments, and clearly promote the formation of a comprehensive supervision force linked by multiple departments.

　　　　　　 Medical insurance flight inspectors come from medical insurance, finance, health, Chinese medicine management and other departments as well as hospitals, information technology companies, insurance companies and other institutions. The "Measures" clarify that the medical security department establishes a communication mechanism with the departments of finance, health, market supervision, Chinese medicine, etc., and can jointly carry out flight inspections when necessary; The clues about the suspected functions of other departments found in flight inspection shall be transferred to relevant departments for handling according to regulations, and the relevant results of flight inspection may be notified to the departments at the same level when necessary. This mechanism will promote the formation of a multi-sectoral comprehensive supervision force led by flight inspection, realize multi-dimensional punishment for the illegal behaviors of the inspected objects, help to enhance the authority of inspection results, increase the impact of flight inspection, and will also more effectively guide designated medical institutions to strengthen self-discipline management, constantly standardize diagnosis and treatment behaviors and improve the efficiency of the use of medical insurance funds.

Accumulated illegal use of medical insurance funds was found to be more than 4.3 billion yuan.

As the people’s "medical money" and "life-saving money", the safe and stable operation of medical insurance fund is very important, which is related to the vital interests of every insured person. With its unique advantages, flight inspection "zero tolerance" has played an important role in curbing the irregular use of medical insurance funds and the problem of fraudulent insurance, and constructing the security system of medical insurance funds.

In recent years, the participation rate of basic medical insurance in China has remained above 95%, and the participation of the whole people is generally stable. The annual expenditure of medical insurance funds exceeds 2.4 trillion yuan, and medical security has effectively played a role in solving the worries of the people about seeing a doctor. Some designated medical institutions illegally use medical insurance funds through hanging bed hospitalization, illegal charges, swapping medical services, excessive diagnosis and treatment, etc. Some even maliciously defrauded the medical insurance fund by means of fictitious medical service items and inducing false medical treatment and drug purchase.

In 2019, the National Health Insurance Bureau began to explore the establishment of a flight inspection mechanism. In the following four years, it successively organized more than 180 flight inspection teams, randomly selected more than 380 designated medical institutions and nearly 150 other institutions, and found that the inspected institutions were suspected of illegally using the medical insurance fund for more than 4.3 billion yuan, which achieved positive results in deterring illegal activities and recovering fund losses. In 2022, more than 2,000 designated medical institutions were randomly selected by provincial flight inspection, and more than 2.2 billion yuan of medical insurance-related funds were recovered, making an important contribution to maintaining the security of medical insurance funds.