Forced Recovery of 77.2 Billion KRW in Health Insurance Funds Over 6 Years... "Ministry of Health and Health Insurance to Establish Legal Grounds"

Korea Commission on Human Rights Deems Recovery of 1 Million KRW Health Insurance Payment from 10 Years Ago "Inappropriate"
Urges Ministry of Health and Welfare and National Health Insurance Service to Establish Legal Grounds and Relief Procedures for Recovery

[Sejong=Asia Economy Reporter Moon Chaeseok]

#Mr. A received a notice of additional collection of 1 million won from the National Health Insurance Service in January 2019. The message stated, "Since you were given 1 million won more than the health insurance payment for some of the hospital expenses (out-of-pocket) after your father's death in 2011, you must (repay) it."

The Anti-Corruption and Civil Rights Commission announced on the 2nd that forcibly recovering already paid health insurance benefits is unfair, and recommended the Ministry of Health and Welfare and the National Health Insurance Service to cancel this and establish clear legal grounds and relief procedures for recovery. The amount recovered from health insurance benefits has reached 77.2 billion won over the past six years.

Under the current National Health Insurance Act, the Service is required to pay health insurance subscribers the amount exceeding the annual out-of-pocket maximum for hospital expenses borne by them.

The problem is that there is no clear legal provision regarding the recovery of overpaid health insurance benefits. The Service has been forcibly recovering the overpaid amount by applying internal regulations, considering it as 'unjust enrichment' under Article 57 of the law.

Accordingly, the Anti-Corruption and Civil Rights Commission judged the additional collection notice to Mr. A as unjust enrichment, canceled the unfair forced recovery measure, and expressed its opinion to the Ministry of Health and Welfare and the National Health Insurance Service to establish legal grounds and relief procedures for recovery.

The grounds cited include: ▲the complainant did not receive insurance benefits through deception or other unfair methods; ▲the cause of recovery arose due to the Service's fault, making it difficult to consider the subscriber as a subject of unjust enrichment collection; ▲dispositions imposing payment obligations on citizens must be based on both legal grounds and procedural laws; and ▲there are no specific procedures for the complainant to oppose the Service's forced collection, such as filing objections.

Lim Jin-hong, the Anti-Corruption and Civil Rights Commission's Grievance Complaint Officer, said, "The authority of administrative agencies should naturally originate from legal grounds, and it is desirable to establish corresponding relief procedures for citizens' rights."

Recent 6-Year Status of Health Insurance Reimbursement. (Source: Anti-Corruption and Civil Rights Commission)

This content was produced with the assistance of AI translation services.