倒查两年半，剑指医院、药店违规乱象！又一省启动医保飞检

Core Viewpoint - The article discusses the upcoming provincial-level inspections of medical insurance funds in Hunan, emphasizing the importance of safeguarding these funds for the benefit of insured individuals and the overall healthcare system [2][5]. Group 1: Overview of Inspections - The Hunan Provincial Medical Insurance Bureau announced a special inspection of medical insurance funds from July to September 2025, covering the usage from January 1, 2023, to June 30, 2025 [2]. - The inspections aim to enhance the supervision of medical insurance funds, with a focus on high-risk areas and behaviors, including fraudulent practices in medical institutions and retail pharmacies [7][10]. Group 2: Inspection Methodology - The inspections will utilize a "no prior notice" approach, allowing for unannounced checks at designated medical institutions [9]. - Key features of the inspections include a cross-checking mechanism, high professional standards, and the formation of specialized teams to improve efficiency [10]. Group 3: Targeted Areas of Concern - Specific areas of focus include fraudulent hospital admissions, excessive hospitalization rates, and violations related to prescription transfers and drug procurement [10][11]. - Retail pharmacies will be scrutinized for fraudulent practices such as falsifying prescriptions and engaging in drug trafficking [11]. Group 4: Broader Regulatory Context - The article highlights ongoing efforts to combat medical insurance fraud, including recent cases of significant fraud involving millions in claims [15]. - The introduction of smart regulatory measures, such as the mandatory scanning of drug traceability codes for insurance settlements, aims to reduce fraudulent activities [16]. Group 5: Involvement of Third Parties - Third-party organizations are increasingly involved in the oversight of medical insurance fund usage, enhancing the regulatory framework through data-driven approaches [17].