LS&HC Horizons 2022 - Flipbook - Page 54
Hogan Lovells | 2022 Life Sciences and Health Care Horizons
54
Asia-Pacific
China’s combat on medical insurance fraud
In keeping with the Chinese government’s continuous focus on
cracking down on corruption in the health care industry, the
National Healthcare Security Administration (NHSA) launched a
nationwide operation in 2018 to combat medical insurance fraud.
According to the NHSA, from 2018 (the year when it was founded)
to the end of October 2021, health care security regulators across
China conducted approximately 2.34 million inspections related to
insurance fraud in medical institutions. Through these inspections,
approximately 50.6 billion RMB (7.94 billion USD) in medical
insurance funds were recovered.
In a statement issued in January 2022, the NHSA discussed
the case of a pharmaceutical giant’s employees suspected of
tampering with the genetic testing results of cancer patients to
defraud medical insurance funds. Following an investigation by the
Chinese government, several employees involved were arrested,
and the NHSA demanded that the company “close loopholes” in
the supervision of marketing activities, as well as conduct internal
training to ensure that employees comply with the local laws. The
NHSA further stated that it will now work with other authorities to
carry out a nationwide campaign against fraud involving genetic
testing results.
To avoid reputational and financial damage amid increasing efforts
to combat medical insurance fraud, health care companies in China,
especially international pharmaceutical companies, are strongly
recommended to carefully review their compliance and incentive
programs to ensure that they have taken all reasonable steps to
reduce the risk of medical insurance fraud.
Calvin Ding
Partner, Shanghai
Matthew Sullivan
Partner, New York
Yang Bai
Associate, Shanghai
