Network coding is a potent technique extensively utilized in decentralized Internet of Things (IoT) systems, including the Internet of Medical Things (IoMT). Nevertheless, the inherent packet-mixing characteristics of network coding expose data transmission to pollution attacks, potentially compromising the integrity of original files. The homomorphic signature scheme serves as a robust cryptographic tool that can bolster network coding’s resilience against such attacks. However, current schemes are computationally intensive for signature verification, making them impractical for IoMT environments. In this study, we propose a lightweight identity-based network coding scheme (IBNS) that minimizes computational overhead during the signing and verification processes. This scheme has been demonstrated to be secure against adaptive chosen-message attacks and is well-suited for IoMT applications. Furthermore, we assess the performance of our IBNS through both theoretical and experimental analyses. Simulation outcomes confirm that our scheme outperforms previous ones in terms of practicality and efficiency.