J Korean Med Assoc.  2013 Aug;56(8):676-685. 10.5124/jkma.2013.56.8.676.

Recent trend of precedents for National Health Insurance

Affiliations
  • 1LawM Law Firm, Seoul, Korea. smartmd@nate.com

Abstract

This paper introduces the major issues related to the Health Insurance Act and the core content of recent precedents, in order to prevent health insurance arguments and to contribute to health insurance-related administrative litigation. The basis of Korea's health insurance system is the National Health Insurance Act. After providing medical services, the medical cost is covered by the National Health Insurance Corporation (NHIC). If the doctor was paid deceptively or improperly, then the NHIC will seize the entire payment, and the Minister of Health and Welfare will order the doctor to suspension practice or, similarly, fine the doctor for five times the original payment. In addition, doctors who have used deception will have their license suspended. If the doctor has any objection against this administrative measure, he or she can file an administrative lawsuit. So far, if the action was illegal, the court has generally made principle-based judgments, regardless of whether the behavior was intentional or negligent; however, recently, especially in cases related to the court of first instance (only a few cases), the court has made a judgment clearly cancelling the measure under the condition that the measure was beyond the level by analyzing the reason why the practitioner committed an offense. From the practitioners' point of view, it is encouraging that the judges have started to understand the reality of the medical field. Further, this paper argues that judges should increase their understanding the medical field and specific validity. This article reviews the litigation process related to the National Health Insurance Act and recent trends in its precedents. From now on, these judgments should support the arguments of practitioners. Con-clusively, these judgments were the result of legal actions; therefore, doctors should avoid taking an attitude of annoyance toward lawsuits or being intimidated by the organization, and as a result, respond passively by simply paying out the lawsuit settlements.

Keyword

National Health Insurance Act; Demand of insurance payment by using deception or other improper way; Suspension of license; Imposition of penalty surcharge; Recent precedents; Administrative litigation
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