China is tightening oversight of its medical insurance system in 2026 through new rules and a nationwide anti-fraud campaign. The measures, introduced by the National Healthcare Security Administration (NHSA), took effect on April 1. This will increase scrutiny in every aspect of the healthcare industry, but some of the changes will predominantly affect hospitals and pharmacies that participate in the public insurance system.
However, pharmaceutical companies may also come under review in certain cases. Authorities are paying more attention to issues such as fake prescriptions, improper patient assistance programs, and promotional activities tied to insurance claims. Based on the severity of the activity, suspected violations may be referred to public security authorities for investigation.
Regulators are also relying more heavily on digital monitoring tools. Beginning this year, reimbursed medicines must carry traceability codes that are scanned during the insurance settlement process. The collected information will be used by authorities to identify unusual purchasing or prescribing activity, such as duplicate claims for reimbursement or suspicious distribution methods.
Foreign companies doing business in China may want to evaluate their internal controls and third-party relationships, as enforcement activity expands.
Written by: Ames Gross – President and Founder, Pacific Bridge Medical (PBM)
Mr. Gross founded PBM in 1988 and has helped hundreds of medical companies with regulatory and business development issues in Asia. He is recognized nationally and internationally as a leader in the Asian medical markets. Mr. Gross has a BA degree, Phi Beta Kappa, from the University of Pennsylvania and an MBA from Columbia University.