The Office of the State Medical Security Administration issued a notice on regulating the management of external prescriptions for medical insurance drugs, coordinating regional health insurance departments to include the inspection of external prescriptions in designated medical institutions and designated retail pharmacies in anti-fraud and insurance fraud. By the end of December 2024, special inspections will be carried out on outpatient chronic and special disease coverage, prescription drugs under the “two diseases” medication mechanism for urban and rural residents, and other prescription drugs with high amounts of money, high costs, and high risk of fraud fraud. Relying on big data analysis, it is necessary to check if the amount of paper prescriptions used is large, the dosage of a single prescription must be checked; the same insured person must be checked for repeated overprescriptions; the number of paper prescriptions prescribed by single designated medical institutions must be checked; and the number of prescriptions prescribed by medical insurance physicians in key departments must be checked. Illegal violations by designated medical institutions and insured persons discovered during the inspection must be promptly investigated and dealt with in accordance with the law and regulations. It is necessary to strengthen health and rule of law education for insured persons, resolutely crack down on doctors and patients colluding to defraud insurance fraud, educate and punish insured persons involved in insurance fraud by comprehensively adopting methods such as credit evaluation and reducing the convenience of health insurance services, and support all regions in exploring appropriate adjustments to the health insurance benefits of fraudulent insurance participants. Where there is a problem of irregularity or violation of the law, the corresponding liability shall be prosecuted in accordance with law.

The Office of the State Medical Security Administration issued a notice on regulating the management of external prescriptions for medical insurance drugs, coordinating regional health insurance departments to include the inspection of external prescriptions in designated medical institutions and designated retail pharmacies in anti-fraud and insurance fraud. By the end of December 2024, special inspections will be carried out on outpatient chronic and special disease coverage, prescription drugs under the “two diseases” medication mechanism for urban and rural residents, and other prescription drugs with high amounts of money, high costs, and high risk of fraud fraud. Relying on big data analysis, it is necessary to check if the amount of paper prescriptions used is large, the dosage of a single prescription must be checked; the same insured person must be checked for repeated overprescriptions; the number of paper prescriptions prescribed by single designated medical institutions must be checked; and the number of prescriptions prescribed by medical insurance physicians in key departments must be checked. Illegal violations by designated medical institutions and insured persons discovered during the inspection must be promptly investigated and dealt with in accordance with the law and regulations. It is necessary to strengthen health and rule of law education for insured persons, resolutely crack down on doctors and patients colluding to defraud insurance fraud, educate and punish insured persons involved in insurance fraud by comprehensively adopting methods such as credit evaluation and reducing the convenience of health insurance services, and support all regions in exploring appropriate adjustments to the health insurance benefits of fraudulent insurance participants. Where there is a problem of irregularity or violation of the law, the corresponding liability shall be prosecuted in accordance with law.