The National Healthcare Security Administration continues to carry out a special campaign to combat illegal and violations in the medical insurance drug sector.

To fully implement and carry out the decision and deployment of the Party Central Committee and the State Council, continue to further deepen the special campaign to address prominent issues in the management of medical insurance funds, and further consolidate and expand the outcomes of the special action to crack down on fraud and misconduct in the field of medicines using drug traceability codes, recently the Office of the National Healthcare Security Administration issued the “Notice on Deepening the Special Campaign to Crack Down on Illegal and Non-compliant Issues in the Healthcare Security Medicines Sector” (hereinafter referred to as the “Notice”). It makes special arrangements for continued efforts to crack down on illegal and non-compliant issues such as the sale of medical insurance “returned-back medicines” at a profit and related conduct.

The “Notice” requires that starting from April 2026, leveraging investigations into suspicious leads regarding drug traceability code matters, the special campaign to crack down on illegal and non-compliant issues in the healthcare security medicines sector will continue to be carried out in depth across the country. The special campaign is divided into two phases: the first phase is from April to July 2026, and the second phase is from September to November 2026. The National Healthcare Security Administration will issue batches of suspicious leads on duplicate settlements of drug traceability codes at the beginning of April 2026 and at the beginning of September 2026, respectively. Local healthcare security departments, together with relevant departments, will coordinate and integrate nationwide leads issued by the state, leads on issuing excessive prescriptions locally, and leads from public reports and complaints, among others, to carry out in-depth investigations and remediation. They will precisely crack down on illegal and non-compliant issues such as the sale of medical insurance “returned-back medicines” at a profit, swapping medical insurance medicines, brushing through or using medical insurance credentials in disguise (“empty brushing” and “stacked brushing”), forging prescriptions, hoarding card-based purchases (“card collection for drug purchases”), and “year-end top-up” consumption. They will promptly recover losses to medical insurance funds, and depending on the severity of the circumstances, adopt measures such as interviews and reminders, deadline-based rectification, suspension of medical insurance settlement, termination of service agreements, credit-point management of medical insurance payment eligibility, and transferring cases to competent industry authorities, judicial authorities, and discipline inspection and supervision authorities for handling.

The “Notice” emphasizes that focusing on all stages and the entire process of selling medical insurance “returned-back medicines,” efforts will continue to strengthen “penetration-style” crackdowns on all categories of implicated entities, including professional prescribers, drug peddlers, as well as illegal and non-compliant wholesale enterprises dealing in medicines, medical and pharmaceutical institutions, and others, to completely sever the illegal chain of “prescribing—selling at a profit—returning back—reselling.” Actively in cooperation with relevant departments, they will conduct joint inspections and joint sanctions to strictly prevent medical insurance “returned-back medicines” from flowing to non-medical-insurance designated medical and pharmaceutical institutions, online drug-selling platforms, or being resold again in the form of self-pay. They will publicly expose a number of representative cases with particularly恶劣性质 and serious circumstances to enhance the role of warning and deterrence.

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Responsible editor: Cao Ruitong