[2022 National Audit] 1,299 Medical Institutions with Unclaimed Health Insurance for 3 Consecutive Years ... "Unfair Billing to Patients"

Assemblywoman Shin Hyun-young, "284 Refund Cases and Over 65 Million Won in Refunds Due to HIRA Investigation"

[Asia Economy Reporter Jo In-kyung] It has been revealed that 1,299 medical institutions have not claimed any health insurance medical fees for three consecutive years. Most of these institutions are engaged in non-reimbursable treatments such as plastic surgery and Korean medicine rather than essential medical care, suggesting the possibility of excessive treatment.

According to data submitted by the Health Insurance Review and Assessment Service (HIRA) to Shin Hyun-young, a member of the National Assembly’s Health and Welfare Committee from the Democratic Party of Korea, among the 1,299 medical institutions that did not claim medical fees for three consecutive years since 2019, 43% (550) were general clinics, 38% (490) were plastic surgery clinics, and 10% (132) were Korean medicine clinics.

In particular, the number of cases where HIRA refunded patients through the "Non-reimbursable Medical Fee Confirmation Application" for medical institutions that did not claim health insurance medical fees reached 284 cases over five years, totaling 65.46 million KRW.

The Non-reimbursable Medical Fee Confirmation System is a remedy system that allows patients to request HIRA to verify whether the non-reimbursable medical fees they paid at medical institutions fall under the scope of health insurance (reimbursable) coverage. While it is not illegal for medical institutions to not claim health insurance fees, Shin explained that thorough verification is necessary because there have been confirmed cases where reimbursable medical fees were treated as non-reimbursable or excessive charges for higher-level hospital rooms were imposed, resulting in refunds to patients.

Earlier, in June 2019, HIRA imposed administrative sanctions such as business suspension and fines on four medical institutions found to have made improper claims, and one institution that refused investigation was subjected to a one-year business suspension and was reported to the local police station. However, despite the annual increase in medical institutions not claiming health insurance fees, no separate on-site investigations have been conducted on these institutions since 2019.

Shin said, "Medical institutions that do not claim health insurance fees mainly provide non-reimbursable treatments focused on plastic surgery, skin care, Korean medicine, hair loss, health checkups, and pain management," adding, "Monitoring is needed to ensure that appropriate medical practices are being carried out and to check whether excessive or unscientific medical practices are taking place." Shin also emphasized, "to discourage the commercialization of medical care, the government should analyze the behaviors of medical providers and consumers, conduct regular investigations, and establish a monitoring system to address blind spots in management."

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