China’s National Healthcare Security Administration (NHSA) achieved a significant milestone in 2025 by recovering approximately 34.2 billion yuan ($4.95 billion) in misappropriated medical insurance funds, according to an official statistical report released on Monday. This substantial recovery represents one of the most successful anti-fraud campaigns in China’s healthcare system history.
The comprehensive audit revealed systematic insurance fraud across 1,626 medical institutions, with 27.8 billion yuan identified and reclaimed through rigorous verification processes. In a coordinated effort with public security authorities, the administration investigated 3,776 separate cases, resulting in the arrest of 10,357 suspects involved in fraudulent activities. The campaign also leveraged whistleblower participation, recovering 2.74 billion yuan through tip-offs while distributing approximately 1.56 million yuan in rewards to informants.
Concurrently, China’s healthcare coverage expanded significantly, with basic medical insurance now encompassing over 1.33 billion citizens—an increase of 4.06 million from the previous year—maintaining a 95% coverage rate nationwide. The combined medical and maternity insurance funds demonstrated robust financial health, recording total revenues of 3.59 trillion yuan against expenditures of 3 trillion yuan.
Service utilization metrics showed notable trends: outpatient visits surged to 7.22 billion (a 25.51% year-on-year increase), while inpatient services declined slightly to 278 million visits (down 3.4%). The healthcare safety net proved particularly effective for vulnerable populations, with coverage for low-income rural residents and those recently lifted from poverty remaining above 99%. The three-tier protection system—combining basic medical insurance, critical illness insurance, and medical assistance—benefited over 246 million rural residents, reducing their medical expenses by approximately 193 billion yuan.
Cross-provincial medical services witnessed substantial growth, with hospitalization expense direct settlements reaching 15.82 million cases (a 10% increase) involving 162 billion yuan in fund payments. Outpatient direct settlements expanded even more dramatically, reaching 292 million visits (30% growth) with 45.5 billion yuan in payments (26% increase).
Maternity insurance coverage expanded to nearly 260 million people, with the fund disbursing 136 billion yuan in benefits to more than 35 million recipients. The national reimbursement drug list expanded with 114 new additions in 2025, bringing the total to 949 drugs added since the NHSA’s establishment in 2018. The administration also completed its 11th round of national centralized drug procurement, covering 55 pharmaceutical products.