Core Viewpoint - The article highlights the increasing regulatory measures by the National Medical Insurance Administration to combat fraudulent practices in medical insurance, particularly focusing on retail pharmacies involved in scams such as drug swapping and false prescriptions [4][6][10]. Regulatory Actions and Cases - The National Medical Insurance Administration has initiated a special rectification campaign from now until December 31, 2025, targeting illegal activities such as selling back medical insurance drugs and fraudulent claims for maternity benefits [6][8]. - A case in Sanya, Hainan Province, revealed a network of pharmacies colluding with intermediaries to exploit insurance funds, resulting in over 3.3 million yuan in fraudulent transactions [8]. - In contrast, a case in Ganzhou, Jiangxi Province, exposed smaller-scale, routine fraud involving the forgery of prescriptions, amounting to 27,711.63 yuan, highlighting the pervasive issue of regulatory non-compliance at the grassroots level [9]. Technological and Systematic Improvements - The implementation of a scoring system for key personnel in pharmacies has been established, where accumulating 12 points leads to the termination of medical insurance payment qualifications for individuals involved in fraud [11]. - The use of advanced technologies such as big data, traceability codes, and real-time monitoring is enhancing the precision and effectiveness of medical insurance fund supervision [11][16]. Achievements and Future Plans - Various regions have reported significant recoveries of misappropriated medical insurance funds through rigorous inspections and self-audits, with Hunan Province recovering 1.95 million yuan from 100 medical institutions [14]. - The article notes that the regulatory framework is evolving towards a more comprehensive and multi-dimensional approach, with a focus on preemptive measures rather than solely punitive actions [13][16]. - Future plans for the "14th Five-Year Plan" period emphasize the need for innovative regulatory methods and enhanced monitoring to safeguard medical insurance funds, particularly in regions with unique challenges [15][16].