According to the official website of the National Healthcare Security Administration, in order to thoroughly rectify the problem of illegal and irregular use of medical insurance funds, continuously increase the supervision of medical insurance funds, consolidate the high-pressure situation of fund supervision, improve and perfect long-term institutional mechanisms, and resolutely safeguard the safety bottom line of medical insurance funds, the National Healthcare Security Administration recently issued a notice on doing a good job in the supervision of medical insurance funds in 2026. The main contents are as follows: firstly, to continue to carry out special rectification of prominent problems in medical insurance fund management. On the basis of consolidating the effectiveness of the special rectification of prominent problems in medical insurance fund management in 2025, the National Healthcare Security Administration will continue to carry out special rectification with relevant departments, and firmly "reduce stock and curb increment" in response to fraud and insurance fraud. Medical insurance departments at all levels should further enhance their ideological awareness, firmly shoulder the political responsibility of maintaining the security of medical insurance funds, take special rectification as the primary task, adhere to the principle of "the top leader" taking overall responsibility, take multiple measures to increase rectification efforts, and continue to promote the deepening and implementation of special rectification work. We must adhere to upholding integrity, innovating, consolidating and deepening, deeply summarize the effective experience and achievements of special rectification, and solidify a batch of mature experience and practices; We must adhere to a problem oriented approach, highlight key areas, closely monitor prominent issues and new situations and problems that have been strongly reflected by the masses, and increase our efforts to crack down on them; We must adhere to the principle of treating both the symptoms and root causes, adopt comprehensive measures, focus on deep-seated problems, strengthen source control, improve long-term mechanisms, and achieve the goal of promoting reform and treatment through investigation. Secondly, we will comprehensively promote the expansion and quality improvement of flight inspections, continuously increase the intensity of flight inspections, coordinate national flight inspections, provincial flight inspections, and city level cross inspections, and comprehensively promote annual flight inspections, special flight inspections, and "targeted" flight inspections to achieve comprehensive coverage of flight inspections in all provinces of the country, including designated medical institutions, handling institutions, insured persons, insured units, and various types of insurance such as basic medical insurance, maternity insurance, major illness insurance, and long-term care insurance. The annual flight inspection focuses on areas with high operational risks of medical insurance funds, abnormally high hospitalization rates, abnormal medical insurance payment rates, and ineffective rectification of flight inspection problems. It also focuses on designated medical institutions with large fund usage, concentrated reporting and big data screening problem clues, and key areas such as orthopedics, oncology, examination and testing, ophthalmology, dentistry, general surgery, neurology, etc. The special flight inspection focuses on prominent issues of illegal and irregular use of medical insurance funds, such as social concerns and strong public feedback. Explore and carry out special flight inspections for long-term care insurance. The key focus of the "point based" flight inspection is to conduct short and fast inspections by big data screening for abnormal clues, reporting and complaining of problem clues, and self funded institutions with abnormally high rates. Provincial medical insurance departments should strengthen organizational leadership, actively cooperate with national flight inspections, carry out in-depth provincial flight inspections, coordinate and guide cross city inspections, and ensure that the 2026 flight inspection work is carried out in a solid and orderly manner. Thirdly, we will expand and deepen the supervision and application of drug traceability codes, continue to carry out special actions to combat illegal and irregular issues in the medical insurance field through the use of drug traceability codes, consolidate the high-pressure situation of cracking down on the resale and return of medical insurance drugs, accurately crack down on drug related illegal and irregular behaviors such as reselling and returning drugs, swapping medical insurance drugs, empty brushing of medical insurance certificates, and excessive drug prescribing. Continuously screen for abnormal clues in drug traceability codes and issue them to local authorities for verification and disposal in stages. Deepen the joint investigation and handling mechanism with public security, drug supervision and other departments, and carry out a full chain penetration crackdown on professional drug dispensers, drug traffickers, drug wholesale enterprises, pharmaceutical institutions, online drug sales platforms, etc. suspected of reselling and returning drugs. Deepen the coordination and linkage with the drug regulatory authorities, promote the extension of the crackdown on the resale of medical insurance drugs to self funded and non designated medical institutions, form a regulatory loop, and comprehensively and deeply curb the long-standing problem of returning drugs. Intensify the application of information technology, fully expose the information of returned drugs, and punish those who resell drugs appropriately. Establish a consensus and atmosphere of "illegal retrieval of returned drugs and criminal sale of returned drugs" in the whole society. The fourth is to innovate and explore cutting-edge technologies such as artificial intelligence and new scenarios for regulatory applications. We will continue to increase the research and application of various big data regulatory models, focusing on typical illegal and irregular behaviors, drug consumables, diagnosis and treatment projects, key populations, disease types, insurance types, etc., and continuously enrich and improve the matrix of big data regulatory models. Continuously innovating and expanding the practical path and application scenarios of "artificial intelligence+medical insurance supervision", based on the construction of "one disease, one file", exploring the development of single disease and multi disease supervision models that are compatible with DRG/DIP payment methods, solving the regulatory difficulties of high staffing and high sets, decomposing hospitalization, and transferring costs under DRG/DIP payment methods, and promoting the transformation of fund supervision from project supervision to collaborative supervision of projects and diseases; Based on the construction of medical insurance image cloud, explore "artificial intelligence+image recognition" to accurately detect illegal and irregular behaviors such as abnormal implanted consumables, false examinations, repeated examinations, and fabricated medical conditions; Based on multidimensional data collection, explore "artificial intelligence+case interpretation" to provide clue support for the supervision of issues such as excessive diagnosis and false diagnosis and treatment; Based on the national medical insurance policy, explore the construction of "artificial intelligence+medical insurance rules", automatically generate regulatory rules, screen suspicious clues, and accurately discover problems through artificial intelligence; Based on new technology research and development, explore the regulatory applications of multiple technologies such as thermal imaging, millimeter wave radar, and scene capture. Continuously promote the transformation and application of the pilot results of anti fraud big data supervision, and embed mature regulatory models from various regions into the national medical insurance information platform after verification by the National Medical Insurance Bureau, and promote their application nationwide. We will deepen the pilot work of intelligent supervision reform, encourage local governments to boldly explore, take the lead, innovate and carry out practical exploration of "artificial intelligence+medical insurance supervision", and timely summarize replicable and promotable experience and practices. The National Healthcare Security Administration will strengthen overall guidance and tracking evaluation, provide policy support and experience promotion for local innovative practices. The fifth is to comprehensively strengthen the verification of clues and the rectification of problem handling. Medical insurance departments at all levels should conscientiously carry out clue verification, and timely feedback the investigation results of the report and complaint clues and big data screening suspicious clues issued by the National Medical Insurance Bureau according to the time limit requirements. Provincial medical insurance departments should strictly control the feedback verification results. We must strictly handle the follow-up of illegal and irregular issues, and comprehensively use methods such as agreement management, administrative penalties, and payment qualification management to ensure the effectiveness of disciplinary education. For institutions involved in fraud and insurance fraud, we will resolutely terminate or suspend the designated medical insurance agreement, strictly refuse to accept designated applications within the prescribed time limit, and impose medical insurance payment qualification points on relevant personnel. Intensify the exposure and internal reporting of typical cases, and strengthen warning and deterrence. Deepen the mechanism of "linking actions, executing actions, and disciplinary actions", and strengthen the investigation of multiple cases and joint punishment. We should draw analogies and use investigation to promote reform and governance. In response to the widespread, regional, and prominent issues identified during inspections, we should use methods such as sincere talks, interviews, and collective education to urge comprehensive self-examination and promote comprehensive governance. The National Healthcare Security Administration will organize special flight inspections in a timely manner, conduct spot checks and reviews on reports and complaints that have doubts about the verification results of issued clues, as well as big data screening suspicious clues, and conduct a "look back" on those that have not been effectively rectified during flight inspections. Those who fail to investigate cases, harbor and condone them, have a superficial style, and are perfunctory will be dealt with seriously. The sixth is to continuously improve the intelligent supervision system for the entire process before, during, and after the event, and to coordinate and promote the construction of the "three lines of defense" for medical institutions, including pre notification, mid event review, and post event supervision, to form a synergistic effect of intercepting illegal and irregular behaviors in a hierarchical manner. Promote the advancement of regulatory checkpoints, strengthen advance reminders, eliminate various illegal and irregular behaviors in their infancy, and continuously reduce the occurrence of illegal and irregular problems. Adhere to the principle of "walking on two legs", accelerate the implementation and application of pre notification systems, and strive to achieve a designated medical institution access rate of over 70% by the end of 2026. For small and medium-sized medical institutions, encourage them to access the pre alert function module of the provincial medical insurance information platform and achieve free access; For large pharmaceutical institutions with strong technical strength and good information technology foundation, it is encouraged to embed the national "two databases" rules and knowledge points into the hospital HIS system to improve operational efficiency and meet personalized management needs. The National Health Insurance Bureau will systematically and systematically release the two database rules dynamically through the deployment of the intelligent supervision system, the public publication of books, the bureau's official website official account and other ways, continue to empower medical insurance departments at all levels and the vast number of designated medical institutions, and provide strong support for advance reminders. Improve the effective linkage mechanism between pre event, during event, and post event work. Regularly summarize and collect mature and effective rules and knowledge points formed during advance reminders and in-process audits, and timely incorporate them into the "two databases" after research and demonstration; Actively promote the intelligent supervision and pre notification of excessive drug prescribing, timely push mature and appropriate rules for post supervision to pre - and in process, and empower pre notification and in process review with post supervision. Seventh, we will continuously improve the long-term regulatory system and accelerate the implementation of the "Regulations on the Supervision and Management of the Use of Medical Security Funds", formulate administrative law enforcement discretion benchmarks, strengthen publicity and training, and implement them in practice. Research and formulate policy measures to further strengthen the supervision and management of the use of basic medical insurance personal accounts for employees of designated retail pharmacies, and standardize the use of personal account funds. Research and develop regulatory systems for long-term care insurance funds. Continuously carry out self-examination and self correction of designated medical institutions, and strengthen the main responsibility of designated medical institutions. Fully implement the qualification management system for medical insurance payment, improve the scoring situation, scoring rules, information disclosure and other measures, accelerate the nationwide networking of scoring information, and encourage designated medical institutions to link personnel scoring with performance evaluation, professional title promotion, and excellence evaluation. Explore and implement a credit management mechanism that emphasizes both incentives and constraints. Carry out pilot projects for credit management mechanisms in designated pharmaceutical institutions, distinguish different types and levels of institutions, comprehensively consider violations of laws and regulations, self inspection and self correction, internal control, cooperation with supervision and inspection, etc., and score points. The score results are linked to inspection frequency, performance evaluation, etc. Eighth, we will actively promote the publicity, education, and guidance of precision drip irrigation. We will formulate the "Guiding Opinions on Further Strengthening the Supervision, Education, and Guidance of Medical Insurance Funds", establish a normalized publicity and education mechanism, guide all entities using medical insurance funds to actively self regulate, self reflect, and self alert, and comprehensively create a good atmosphere for the rational and standardized use of medical insurance funds. Adhere to the combination of positive and negative aspects, strengthen the intensity and frequency of publicity and training, continue to organize the centralized publicity month activities for the supervision of medical insurance funds, and enhance the grasp and understanding of medical insurance laws, regulations, policies and systems by various sectors of society through door-to-door policy delivery, special training, centralized publicity, and Q&A, etc; Select typical negative cases to carry out case studies and warning education. Adhere to the principle of distinguishing between internal and external factors, and follow the principle of "distinguishing nature and classifying disposal" to resolutely publicly expose and strengthen warning and deterrence for problems that are of a bad nature, have not been corrected repeatedly, or are widely existing; For general violations and emerging tendencies with relatively minor circumstances, education and guidance will be strengthened through extensive coverage, frequent window guidance, sincere talks, internal notifications, and other methods. Adhere to precise drip irrigation, targeting different entities such as hospitals, pharmacies, and insured persons, as well as public and private entities with different natures and scales, such as large, medium, and small, and engaging in fraudulent insurance practices, excessive diagnosis and treatment, and illegal charging, etc., classify and produce targeted and typical warning education materials, and widely carry out training and education in categories. Through precise and effective "ringing the alarm bell", promote case based reform and treatment. Ninth, we will focus on strengthening the rule of law, standardization, professionalization, and clean construction of fund supervision. We will adhere to the rule of law in administration, standardize administrative discretion, improve fund supervision and law enforcement procedures, and strengthen law enforcement supervision. Comprehensively promote the national medical system