Recently, the State Council Information Office held a series of themed press conferences on "Promoting High-quality Development". Yan Qinghui, deputy director of the National Medical Insurance Administration, said that so far, a total of 432 designated medical institutions in 30 provinces have been inspected. It is expected that the number of inspected institutions this year will exceed the total of the past five years, and the expansion is relatively large.

According to incomplete statistics from Cyber Blue, as of September 18, the national flight inspection team has landed in Hebei, Shanxi, Liaoning, Jilin, Heilongjiang, Jiangsu, Zhejiang, Anhui, Fujian, Shandong, Henan, Hubei, Hunan, Guangdong, Hainan, Sichuan, Guizhou, Yunnan, Shaanxi, Gansu, Qinghai, Inner Mongolia, Guangxi, Tibet, Ningxia, Xinjiang, Beijing, Shanghai and other places (see the attachment at the end of the article for details).

According to the work arrangements of the National Medical Insurance Administration, all provinces across the country will complete the national flight inspection on-site inspection before the end of September. There are nearly two weeks left until the end of September, and the national medical insurance fund flight on-site inspection has covered the vast majority of provinces, cities, and autonomous regions.
The national medical insurance inspections are stationed in various places. There are two types: directly announcing the inspected institutions/retail pharmacies at the launch meeting, such as Guangdong, Wuhan, Hubei, Shanxi, Jilin, etc., and giving the list of planned inspections and the time arrangement. The latter involves Fujian, Sichuan, Gansu, Heilongjiang, etc.
At the same time, a new round of inspections of large hospitals is also continuing. The General Office of the National Health Commission issued the "Large Hospital Inspection Work Plan (2023-2026)", and this round of inspections will be completed by the end of October 2026.

The National Health Commission and 14 other departments issued the "Notice on Printing and Distributing the Key Points for Correcting Unhealthy Trends in the Field of Medical Purchase and Sales and Medical Services in 2024", which mentioned that the main responsibility of running a medical institution should be implemented and the inspection of large hospitals should be carried out.
Yan Qinghui, deputy director of the National Medical Insurance Administration, said that before the national bureau's inspections began, it specially organized designated medical institutions across the country to conduct self-inspection and self-correction against the problem list to promote medical institutions to more consciously standardize medical service behaviors. So far, designated medical institutions at all levels have returned about 3 billion yuan in medical insurance funds.
Local governments have stepped up their crackdown efforts, and a number of institutions suspected of fraud and insurance fraud have been terminated and transferred to the police.

The National Medical Insurance Fund flight inspections are carried out while reporting. At present, Henan, Liaoning and other places have reported the list of hospitals that illegally use the National Medical Insurance Fund. For example, when carrying out tumor marker detection projects, the First Affiliated Hospital of Wenzhou Medical University and the Second Affiliated Hospital of Zhejiang University School of Medicine issued additional male examination items, total prostate-specific antigen assay (TPSA) and free prostate-specific antigen assay (FPSA), to female patients. The two hospitals were involved in illegal charges of 1,263 and 996 people, respectively.

In addition, some public hospitals have produced gynecological projects such as "hysteroscopy" and "cervical cancer screening" in the examination of male patients. According to the list exposed by the National Medical Insurance Bureau, Leiyang People's Hospital in Hengyang, Hunan alone conducted 1,674 such illegal inspections in one year. Compared with other hospitals, the problems exposed by naming and reporting the top three hospitals are more typical and the deterrent effect is more obvious.
Some people in the industry believe that the National Health Insurance Administration has made it clear that the notification of women opening men's health project tests is the simplest and clearest violation. In the future, big data screening will be more comprehensively used in the supervision of medical insurance funds. Overall, violations of medical insurance in hospital medical services are more complicated and difficult to supervise than the random swiping of medical insurance cards in pharmacies.

According to the "Statistical Bulletin on the Development of National Medical Insurance in 2023", 18.65 billion yuan of medical insurance funds will be recovered in 2023. The National Health Insurance Administration organized 34 flight inspections, inspected 66 designated medical institutions and 32 medical insurance agencies, and found 920 million yuan of suspected illegal and irregular funds.

Flight inspections have become an effective way to manage the "big pool" of medical insurance funds. Since the establishment of the flight inspection work mechanism in 2019, the National Health Insurance Administration has organized more than 200 inspection teams in 5 years, and spot-checked nearly 500 designated medical institutions across the country. Provinces have followed suit to establish provincial flight inspection work mechanisms, and more than 5,000 designated medical institutions have been spot-checked since 2022.
National and provincial flight inspections have recovered more than 8 billion yuan in medical insurance-related funds. Overall, the intensity of medical insurance fund flight inspections has gradually increased and the means have been continuously innovated.

For medical institutions, flight inspections are also a comprehensive inspection of their own internal and external problems. In terms of process design, medical institutions should strictly manage the distribution and storage of drugs, consumables and reagents, and conduct full-process barcode traceability management of drugs or consumables; in terms of information construction, establish a unified medical insurance fund data standard for hospitals.
Although the flight inspection targets designated medical institutions/designated retail pharmacies, pharmaceutical companies/device companies are no exception. Behind the groups of data from the flight inspections, whether the use of drugs, equipment and consumables is illegal directly involves the promotion behavior of pharmaceutical companies/device companies, and can even be traced back. The pressure on pharmaceutical companies to establish compliance standards is becoming more and more urgent, especially the interaction with medical institutions is the most critical.

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