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

To thoroughly implement the decisions and arrangements of the CPC Central Committee and the State Council, continuously deepen the special campaign for prominent issues in medical insurance fund management, and further consolidate and expand the results of the special campaign targeting fraud and other violations in the field of medical insurance-covered drugs through the application of drug traceability codes, recently, the Office of the National Healthcare Security Administration issued the Notice on Further Launching a Special Campaign to Crack Down on Illegal and Noncompliant Issues in the Field of Healthcare Security Drugs (hereinafter referred to as the “Notice”). It has made special arrangements for continued efforts to crack down on illegal and noncompliant issues such as the sale of medical insurance “returned drugs,” etc.

The “Notice” requires that starting from April 2026, with verification of drug traceability code suspicious leads as the starting point, the special campaign to crack down on illegal and noncompliant issues in the field of healthcare security drugs 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 regarding repeated 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 nationally issued leads, leads about excessive prescribing locally, leads from public举报/complaints, and other sources. They will conduct in-depth verification and remediation, and precisely crack down on illegal and noncompliant issues such as the sale of medical insurance “returned drugs,” swapping medical insurance drugs, brushing or fraudulent use of medical insurance credentials, forging prescriptions, pocketing card fees to purchase drugs, and “ceiling-top” consumption at year-end. They will promptly recover losses to medical insurance funds. Depending on the severity, measures will be taken separately, including interviews and reminders, deadline-based rectification, suspension of medical insurance settlement, termination of service agreements, credit scoring management for medical insurance payment qualification, and transferring cases to industry competent authorities, judicial bodies, discipline inspection and supervision authorities, and other handling measures.

The “Notice” emphasizes that it will focus on all stages and the entire process of selling medical insurance “returned drugs,” and will continue to strengthen “through-the-crime-chain” crackdowns on all categories of involved parties, including professional prescribers, drug peddlers, and illegal and noncompliant drug wholesale enterprises and pharmaceutical institutions. It will completely sever the illegal chain of “prescribing drugs—selling illegally—returning to market for resale—selling.” It will actively coordinate with relevant departments to conduct joint inspections and joint penalties, and strictly prevent medical insurance “returned drugs” from flowing to non-medical-insurance designated medical institutions and pharmaceutical institutions, online drug sales platforms, or being resold again in the form of self-pay. It will publicize and expose a batch of typical cases with particularly恶劣 nature and serious circumstances, to strengthen the role of warning and deterrence.

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责任编辑：曹睿潼