Last year, the medical insurance system recovered 34.2 billion yuan in funds, and police arrested 10,357 suspects of insurance fraud.

On March 16, 2026, the National Healthcare Security Administration released the 2025 Statistical Bulletin on the Development of Medical Security. It shows that last year, 1,626 institutions nationwide were found to have committed insurance fraud, and police arrested 10,357 suspects.

Data indicates that by the end of 2025, the number of people enrolled in basic medical insurance reached 1,330,681,400, an increase of 4.06 million compared to the previous year, with an enrollment rate maintained at 95%. Employee medical insurance enrollment was 385.6 million, and resident medical insurance enrollment was 942.1 million. In 2025, the total income and expenditure of the basic medical insurance fund (including maternity insurance) were 3.5873 trillion yuan and 3.0009 trillion yuan, respectively. The employee basic medical insurance fund (including maternity insurance) income was 2.4647 trillion yuan, with a pooled fund income of 1.8318 trillion yuan; expenditures totaled 1.9352 trillion yuan, with pooled fund expenditures of 1.3574 trillion yuan. The urban and rural residents’ basic medical insurance fund income was 1.1226 trillion yuan, with expenditures of 1.0657 trillion yuan.

Regarding fund supervision, the bulletin shows that in 2025, the national medical insurance system recovered a total of 34.2 billion yuan, including 27.8 billion yuan recovered through review and verification by insurance agencies. A total of 1,626 institutions involved in insurance fraud were identified, 1,678 cases were transferred to judicial authorities, 19,000 cases to disciplinary inspection and supervision agencies, and 59,000 cases to health and other administrative departments. Joint efforts with public security authorities led to the investigation of 3,776 medical insurance cases, and 10,357 suspects were arrested. Intelligent supervision systems recovered 3 billion yuan in losses. In 2025, a total of 1.558 million yuan in reward funds were issued for tip-offs, and 2.74 billion yuan in insurance funds were recovered through reports.

In recent years, the National Healthcare Security Administration has continued to intensify efforts to investigate illegal activities such as insurance fraud. Earlier this year, it issued a notice titled “On Strengthening the Supervision of Medical Security Funds in 2026,” stating that the agency will work with relevant departments to carry out special rectification campaigns, ensuring comprehensive inspections across all provinces. The focus will be on regions with high risks in fund operation, abnormally high hospitalization rates, irregular payment rates, and poor rectification of inspection issues. It will also target medical institutions with large fund usage, frequent reports, and big data screening issues, especially in key areas such as orthopedics, oncology, diagnostics and testing, ophthalmology, dentistry, general surgery, and neurology.

The Supreme People’s Procuratorate previously announced that in 2025, it collaborated with the Ministry of Public Security, the National Healthcare Security Administration, the National Health Commission, and the Ministry of Finance to carry out special campaigns against insurance fraud. From January to November 2025, prosecutors handled over 3,500 cases of insurance fraud, strictly punishing offenders across the entire chain.

The national medical security work conference held in December 2025 revealed that over the past five years, medical insurance departments at all levels recovered approximately 120 billion yuan through agreements, administrative penalties, and other measures.

Additionally, in recent years, the National Healthcare Security Administration has been promoting the establishment of a traceability code system for medicines. On March 19, 2025, four departments, including the National Healthcare Security Administration, jointly issued a notice titled “On Strengthening the Collection and Application of Medicine Traceability Codes in Medical Security and Work Injury Insurance,” requiring that from July 1, 2025, sales must be scanned with traceability codes before medical insurance settlement can occur. Starting January 1, 2026, all medical institutions must fully implement the collection and upload of medicine traceability codes. This marks the official entry of China’s medical insurance fund supervision into a new era of strict traceability code regulation.

The statistical bulletin shows that in 2025, the national medical insurance information platform collected a total of 100.182 billion traceability code records for medicines and consumables from designated medical institutions, connecting with 102,730 institutions. It also collected 44.307 billion traceability records from production and distribution channels, with over 3,572 pharmaceutical manufacturing and distribution companies uploading and downloading traceability information through the platform. The “Medical Insurance Drug and Consumables Traceability Information Query” feature was launched on the national insurance service platform app and mini-program, with daily query volumes exceeding 5 million.

In 2025, using medicine traceability codes to combat the trafficking of “reflowed drugs,” authorities verified over 240,000 suspicious clues, inspected 124,700 designated medical institutions, and handled 39,100 illegal organizations. Joint operations with public security agencies led to the busting of 695 cases of reflowed drug trafficking and the arrest of 2,576 professional fraudsters.