关键词阅读：医保 长护险 责任编辑：栎树 2026年2月2日，国家医疗保障局召开全国医疗保障系统党风廉政建设和反腐败工作视频会议。会议要 求，要健全多层次医疗保障体系，巩固全民参保成果，完善生育保险制度，全面推行长期护理保险，推 动医保影像互通互认，持续优化医保经办管理服务；注重务实求实真抓实干，稳妥推进基本医保省级统 筹，全面推进医保基金即时结算、直接结算、同步结算，深化医保支付方式改革、医疗服务价格改革， 开展真实世界医保综合价值评价试点，加强多层次目录管理，全链条支持创新药和医疗器械发展；及时 防范化解风险挑战，深化医保基金管理突出问题专项整治，严肃查处基金赤字问题，严厉打击欺诈骗保 行为，严守意识形态安全底线。 ...

21世纪经济报道记者王峰北京报道 2月5日上午，最高人民检察院举行"强化刑事检察监督 推进更高水平平安中国建设"新闻发布会，通报检察机关高质效履 行刑事检察职能，推进更高水平平安中国建设情况。 最高人民检察院副检察长苗生明介绍，最高检开展医保基金管理突出问题专项整治，会同公安部、国家医保局、国家卫健委、财政部等部门开展医保领域打 击欺诈骗保专项工作，聚焦治理重点诊疗领域、重点药品耗材以及虚假诊疗等高发多发违法犯罪行为，2025年1至11月共起诉医保领域欺诈骗保犯罪2272 人，推动形成高压态势，守护人民群众"救命钱"。 聚焦劳动者权益保护，起诉拒不支付劳动报酬犯罪1067人，追索欠薪2.1亿元，有效化解劳资矛盾，维护劳动关系和谐稳定。依法惩处破坏环境资源犯罪， 提起公诉2.95万人，为老百姓守护好绿水青山蓝天净土。坚持"四个最严"要求，依法严厉打击危害食品、药品安全犯罪，提起公诉1.1万人，有力维护人民群 众食药安全。 发布会现场 王峰摄 苗生明介绍，2025年1至11月，全国检察机关共起诉故意杀人、抢劫、绑架等严重暴力犯罪4.9万人，同比下降10.3%，占起诉总人数的3.9%，持续维持近10 年的4%以下较 ...

新京报讯据最高检消息，最高检党组成员、副检察长苗生明在发布会上介绍，检察机关加强民生领域司 法保护，切实维护人民群众切身利益。开展医保基金管理突出问题专项整治，会同公安部、国家医保 局、国家卫健委、财政部等部门开展医保领域打击欺诈骗保专项工作，聚焦治理重点诊疗领域、重点药 品耗材以及虚假诊疗等高发多发违法犯罪行为，1至11月共起诉医保领域欺诈骗保犯罪2272人，推动形 成高压态势，守护人民群众"救命钱"。 ...

Core Viewpoint - Guangdong Province is launching a "Hundred-Day Action" to combat fraud and illegal use of medical insurance funds, aiming to protect the integrity of the medical insurance fund and the rights of insured individuals [1] Group 1: Action Details - The action will run from now until the end of December 2025, focusing on collecting reports of significant issues in medical insurance fund management [1] - The initiative is in response to a notice from the National Medical Insurance Administration regarding the management of medical insurance funds [1] Group 2: Reporting Incentives - The Guangdong Medical Insurance Bureau will provide financial rewards to whistleblowers based on the value of the reported cases, with a maximum reward of 200,000 yuan and a minimum of 200 yuan [1] - The types of issues that can be reported include the resale of medical insurance "return drugs," excessive prescription of medications, and fraudulent claims for maternity benefits [1]

Core Viewpoint - The Guangdong Provincial Medical Insurance Bureau has initiated a public solicitation for clues regarding prominent issues in the management of medical insurance funds, as part of a "Hundred-Day Action" aimed at rectifying these problems [1] Group 1: Issues Being Addressed - The solicitation focuses on several key issues, including the resale of medical insurance "return drugs," excessive prescription of medications, and fraudulent claims related to maternity benefits [1] Group 2: Reporting and Rewards - The National Medical Insurance Administration and the Ministry of Finance have established a reward system for reporting violations, offering financial incentives to whistleblowers based on the value of the case, with rewards ranging from a minimum of 200 yuan to a maximum of 200,000 yuan [1]

Core Points - Guangdong Province's Medical Insurance Bureau has initiated a public solicitation for clues regarding prominent issues in the management of the medical insurance fund, as part of a "100-day action" campaign, effective immediately until the end of December 2025 [1] - The National Medical Insurance Administration and the Ministry of Finance have released a reward mechanism for reporting illegal use of medical insurance funds, offering financial rewards to whistleblowers based on the case value, with a maximum reward of 200,000 yuan and a minimum of 200 yuan [1] Summary by Category - **Policy Initiative** - The Guangdong Medical Insurance Bureau is actively seeking public input to address issues in medical insurance fund management through a structured campaign [1] - **Reward Mechanism** - A new reporting reward system has been established, allowing whistleblowers to receive financial incentives for reporting violations, with specific guidelines outlined in local implementation rules [1]

Core Points - The National Medical Insurance Administration (NMIA) is launching a nationwide "100-day action" to combat illegal activities related to the misuse of medical insurance funds, particularly focusing on the resale of returned drugs, excessive prescriptions, and fraudulent claims for maternity benefits [1] Group 1: Key Focus Areas - The "100-day action" will run from September 24, 2025, to December 31, 2025, targeting three main issues: resale of returned drugs, excessive prescriptions, and fraudulent maternity benefit claims [1] - In addressing the resale of returned drugs, the action will focus on investigating practices such as falsifying prescriptions, misuse of medical insurance vouchers, and illegal sales of medical insurance drugs by both medical institutions and insured individuals [1] - For excessive prescription issues, the action will monitor abnormal prescription and purchase behaviors using drug traceability data, particularly focusing on cases that exceed clinically reasonable usage [1] Group 2: Implementation and Coordination - The NMIA emphasizes the importance of digital empowerment, enhanced coordination, and strict legal enforcement to ensure the effective implementation of the "100-day action" [1] - Local medical insurance departments are required to strengthen their efforts in addressing these issues and ensure that the objectives of the "100-day action" are met [1]

Core Viewpoint - The National Healthcare Security Administration (NHSA) is launching a "Hundred-Day Action" campaign to address prominent illegal activities in the medical insurance sector, focusing on issues such as the resale of medical insurance drugs, excessive prescriptions, and fraudulent claims for maternity benefits [1] Group 1: Campaign Objectives - The "Hundred-Day Action" aims to tackle three key illegal activities: resale of medical insurance drugs, excessive prescriptions, and fraudulent maternity benefit claims [1] - The campaign emphasizes concentrated efforts and precise rectification to ensure compliance with laws and regulations [1] Group 2: Expected Outcomes - The NHSA aims to fundamentally eliminate the resale of medical insurance drugs and similar issues across the country [1] - The initiative is designed to deeply purify the operational environment of medical insurance funds [1]

Core Insights - The National Healthcare Security Administration (NHSA) of China has announced seven typical cases of individual fraud against the healthcare insurance system, marking the first public disclosure since the initiation of a special rectification campaign for healthcare fund management issues [1][2]. Group 1: Fraud Cases - The seven cases involve various fraudulent activities, including impersonation for medical treatment and the resale of healthcare drugs [1]. - Specific cases include: - A case in Shenzhen where an individual named Li impersonated others to obtain medical services and resold drugs [1]. - A couple in Beijing involved in reselling healthcare drugs [1]. - Individuals in Hubei and Shanghai also implicated in similar drug resale schemes [1]. - A case in Xinjiang involving false invoicing for reimbursement [1]. - A case in Jilin where an individual sought double reimbursement for medical expenses already paid by a third party [1]. - A case in Tianjin involving impersonation for medical treatment [1]. Group 2: Regulatory Measures - Big data screening has played a crucial role in identifying these fraudulent activities, with the Shenzhen healthcare bureau utilizing data models to monitor abnormal prescription behaviors [2]. - The NHSA has emphasized a "zero tolerance" policy towards fraud, indicating that regulatory efforts will be intensified through the use of technology such as drug traceability codes and enhanced inter-departmental collaboration [2].

Core Viewpoint - The National Medical Insurance Administration is intensifying efforts to combat fraudulent activities related to medical insurance funds, emphasizing the importance of safeguarding public health resources and ensuring the sustainability of the medical insurance system [1][8]. Group 1: Fraud Cases - Case 1: In Shenzhen, an individual named Li exploited others' medical insurance accounts to sell drugs illegally, defrauding the medical insurance fund of 93,013.68 yuan, with total illegal transactions amounting to 169,025.00 yuan [1]. - Case 2: In Beijing, a couple named Yu and Wang were caught selling medical drugs at lower prices, acquiring drugs worth over 110,000 yuan, and were sentenced to 1 year and 2 months in prison [2]. - Case 3: In Hubei, two individuals, Qiu and Ke, misused their outpatient chronic disease benefits to sell drugs, resulting in a total fraud amount of 408,25.78 yuan [3]. - Case 4: In Shanghai, a retiree named Hu was found selling drugs purchased through medical insurance, leading to a recovery of 5,223.31 yuan in funds [4]. - Case 5: In Xinjiang, a retiree named Tan submitted fraudulent medical bills totaling 426,218.45 yuan over several years, resulting in a prison sentence of 3 years [5]. - Case 6: In Jilin, an individual named Gao fraudulently claimed reimbursement for medical expenses already covered by a third party, amounting to 27,394.69 yuan [6]. - Case 7: In Tianjin, Zhang was found to have used another person's medical insurance card to claim medical expenses of 11,284.99 yuan [7]. Group 2: Regulatory Actions - The National Medical Insurance Administration, in collaboration with various governmental departments, is conducting a nationwide crackdown on fraudulent activities, highlighting the importance of maintaining a high-pressure regulatory environment [1][8]. - The administration is utilizing big data and technology to monitor and identify suspicious activities related to medical insurance claims [2][4][6]. - There is a strong emphasis on educating the public about the legal implications of fraud and the importance of adhering to medical insurance regulations [8].