National Health Insurance Service's Long-Awaited 'Special Judicial Police' Introduction, Will It Be Delayed This Year?

The long-standing wish of the National Health Insurance Service (NHIS), the 'Special Judicial Police (Teuksagyeong)' bill, is unlikely to pass the 21st National Assembly as well. The regular session of the 21st National Assembly is scheduled to end in early next month, and it will soon lead to the general election period. Teuksagyeong is an organization that, according to the Criminal Procedure Act, allows general public officials to conduct investigations within a specific scope of duties under the direction of a prosecutor.

According to the medical community on the 15th, a bill granting Teuksagyeong authority to the NHIS to crack down on hospitals run by non-medical managers and pharmacies lending pharmacist licenses (mendae pharmacies) is expected to be submitted soon to the subcommittee of the National Assembly's Legislation and Judiciary Committee. If this subcommittee approval fails, it will be realistically difficult to process the bill in the 21st National Assembly. For the legislation to materialize, it must pass the subcommittee, then the full Legislation and Judiciary Committee meeting, and finally the plenary session. Once the 21st National Assembly ends, the bill will be automatically discarded. The situation is not easy. There are many bills piled up in the Legislation and Judiciary Committee, and there is opposition between stakeholders such as the National Police Agency and the Korean Medical Association. Concerns about the expansion and misuse of investigative authority, such as the expansion of investigations into fraudulent claims, are the opposing views. The atmosphere inside the NHIS is also that "it will not be easy."

Earlier, on September 12, the Legislation and Judiciary Committee held the 1st Bill Review Subcommittee meeting and intended to review four bills on the 'Act on Persons Performing the Duties of Judicial Police Officers and Their Scope of Duties,' but due to scheduling, they could not even proceed.

The Teuksagyeong bill has been a strongly promoted issue by the NHIS since the 20th National Assembly. Past directors have cited the introduction of Teuksagyeong as the institution's biggest long-standing project and have worked hard by personally lobbying for its passage in the National Assembly. It is said that medical institutions operated by non-medical personnel often focus on profit rather than patient health or treatment, resulting in low-quality medical services or excessive treatment. Moreover, since their establishment itself is illegal, they cannot claim medical fees from health insurance, but they make fraudulent claims, worsening the health insurance finances.

From 2009 to December 2021, the total amount recovered from 1,698 illegally established institutions detected and decided for recovery over 13 years reached 3.3764 trillion KRW. The recovery rate is only 6.02% (202.6 billion KRW). This is because many hospitals close during the investigation process. Among the 1,698 illegally established institutions, 1,635 (96.3%) have closed to date. More than 80% of these institutions closed during the investigation. Currently, the average time for investigative agencies to investigate hospitals run by non-medical managers is 11.8 months (up to 4 years and 5 months). If Teuksagyeong is introduced, the investigation time is expected to be reduced to about 3 months. The NHIS judged that the introduction of the Teuksagyeong system would result in a financial saving effect of about 200 billion KRW.

The NHIS currently participates in the approval review for hospital-level establishment to monitor and block suspected illegal establishments from the initial stage. From September 2020 to June this year, there have been 13 cases where approval was denied due to suspicion of illegal establishment. After detection, the NHIS plans to simplify the pre-procedures for property seizure to recover health insurance funds obtained unfairly and strengthen follow-up investigations on high-amount defaulters.

If the bill fails to pass in this session, the NHIS will attempt again in the 22nd National Assembly. A National Assembly official said, "There is some consensus on the introduction of Teuksagyeong, but due to ongoing tensions between the two major parties, it is unlikely to pass in this session."

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