(Yicai Global) June 7 -- The regulator of China’s state medical insurance fund recently unveiled the start of unannounced annual inspections. According to the watchdog’s first-ever published work plan, rule-violating charges for Covid-19 nucleic acid and antigen tests will be a new focus of the surprise checks.

The use of medical insurance funds at national designated medical institutions as well as county- and district-level hospitals for the past two and a half years has been included in the scope of the snap inspections, which will be carried out on-site without giving the targets prior notice.

Medical insurance funds can be used to reimburse the cost of nucleic acid tests only of people confirmed or suspected of having Covid-19. As medical institutions have done a huge amount of testing over the period of the recent coronavirus outbreaks in China, overcharging and non-standard charging have become new risk points.

Last year, the National Healthcare Security Administration made surprise inspections on the use of medical insurance funds at 68 designated healthcare institutions in 29 provinces. The targets were found to have problems with medical insurance management and other issues such as imposing repeated and extra charges. Medical insurance funds worth CNY503 million (USD75.4 million) were allegedly involved in the breaches.

Large hospitals have been the focus of snap checks since an insurance fund fraud at Tongji Hospital, an affiliate of Tongji Medical College at the Huazhong University of Science and Technology, an NHSA insider told Yicai Global.

The orthopedics department of Tongji Hospital swapped and faked the registration of high-value medical consumables between January 2017 and September 2020, thereby swindling China’s medical insurance fund out of CNY23.3 million (USD3.5 million), the NHSA reported this April following an investigation.

Based on experience and the problems found in the past, this year’s surprise checks will mainly focus on hemodialysis and high-value medical consumables, according to Liao Cangyi, an associate professor at the School of Political Science and Public Administration of China University of Political Science and Law.

Editors: Liao Shumin, Futura Costaglione