Report medical insurance fraud, receive reward

China's top healthcare insurance watchdog has launched an online whistleblower platform for the public to report medical insurance fraud and safeguard the security of its funds.

The National Healthcare Security Administration announced on Monday that the tipoff channel is available through its official WeChat account. Eligible informants can receive a one-time reward ranging from 200 yuan ($27.3) to 200,000 yuan, depending on the value of the information provided, the administration said.

China has maintained a zero-tolerance policy toward medical insurance fraud and is committed to severely punishing fraudsters.

Last year, the administration recovered 27.5 billion yuan in misused medical insurance funds and identified 2,008 fraudulent agencies, according to Gu Rong, head of the administration's fund supervision department.

Speaking at a news conference in January, Gu said authorities investigated 3,018 medical insurance cases in cooperation with public security agencies, leading to the arrests of 10,741 criminal suspects.

"A number of agencies committing fraud have had their insurance agreements terminated or suspended and have been referred to public security and disciplinary inspection bodies to intensify the crackdown on fraudulent practices," Gu said.

The administration has deployed big data supervision models to enhance fraud detection and conduct flight inspections. For instance, models targeting abnormal hospitalization records and the resale of insurance-covered drugs have helped recover nearly 600 million yuan.

China has also implemented drug traceability codes — unique electronic identification tags for each medication — to combat fraudulent activities such as the resale and substitution of insured medications and misuse of insurance cards.

Additionally, a credit system has been developed for hospital and pharmacy personnel authorized to process insurance funds to strengthen oversight.

In November, the administration held its first public recognition event for whistleblowers. Six individuals from Beijing, the Xizang autonomous region and the provinces of Jiangsu, Guangdong, Heilongjiang and Zhejiang received a total of 721,400 yuan in rewards.

One of the most high-profile medical insurance fraud cases in recent years was exposed in September after a local doctor in Wuxi, Jiangsu, tipped off the media.

The case, involving Wuxi Hongqiao Hospital, prompted local and national healthcare insurance regulators to launch an investigation. Authorities found the hospital had illegally used 22.3 million yuan in funds, including 11.79 million yuan obtained through fraudulent acts such as fabricating medical records and coaxing insured individuals to falsify hospitalization records.

In November, the hospital was fined 58.96 million yuan and had its operating license revoked.