Constitutional Court: Law Must Be Amended to Allow Medical Benefits if 'Samujang Hospital' Accusation Is Cleared

The Constitutional Court has ruled that the law should be amended to allow long-term care hospitals, which were denied medical benefits after being identified as 'Samu-jang Hospitals' (administrative director hospitals) through investigations by investigative agencies, to receive benefits belatedly if it is later revealed that they are not Samu-jang Hospitals.

Constitutional Court [Photo by Yonhap News]

According to the legal community on the 29th, the Constitutional Court, after consolidating two constitutional complaints filed by two medical corporations and a constitutional review request submitted by the Daejeon High Court, unanimously ruled that Article 47-2, Paragraph 1 of the National Health Insurance Act, specifically the phrase 'Article 33, Paragraph 2 of the Medical Service Act,' is unconstitutional.

A declaration of unconstitutionality acknowledges the unconstitutionality of a legal provision but allows it to remain in effect for a set period to prevent confusion that would arise from immediate invalidation. The Constitutional Court stipulated that if the National Assembly does not amend the provision by the end of next year, the provision will lose its effect.

The two medical corporations that filed the constitutional complaints had their representatives and operators prosecuted on charges of violating the Medical Service Act for establishing and operating Samu-jang Hospitals under the names of medical personnel or non-profit corporations, despite lacking qualifications to open medical institutions.

The police and prosecution notified the National Health Insurance Corporation that the hospitals operated by these corporations were confirmed to be Samu-jang Hospitals, and accordingly, the Corporation withheld payment of medical benefits under the National Health Insurance Act.

Article 47-2, Paragraph 1 of the National Health Insurance Act stipulates cases in which the Corporation may withhold payment of medical benefits, including when an investigative agency confirms that a hospital is a Samu-jang Hospital.

The two medical corporations, whose medical benefits payments were denied, filed administrative lawsuits seeking cancellation of the dispositions and simultaneously filed constitutional complaints requesting confirmation that the legal provision allowing withholding of medical benefits is unconstitutional. The appellate court in one corporation’s administrative lawsuit also requested a constitutional review ex officio.

The Constitutional Court judged that the provision allowing withholding of medical benefits to Samu-jang Hospitals is appropriate. It recognized the suitability of the measure because it is difficult to recover undue benefits after payment.

However, the Court pointed out, "The provision in the National Health Insurance Act relaxes the conditions for withholding payment by allowing it once the fact that the hospital is a Samu-jang Hospital is confirmed by investigation results, but there is no legislative regulation for appropriate cancellation of the withholding when it is later revealed that the hospital is not a Samu-jang Hospital."

It also stated, "The public interest aimed at by this provision is to promote the financial soundness of health insurance by excluding the possibility that medical benefits paid to Samu-jang Hospitals cannot be recovered, but it cannot be concluded that the disadvantage suffered by the medical institution operator is minor compared to the public interest," adding, "It lacks a balance of legal interests."

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