Recovery of Undue Profits through Voluntary Inspections of Care Institutions

Seven Items, Including "Discrepancies in the Purchase and Claim of Anti-Atherosclerotic Agents," to Be Sequentially Inspected Starting in March

The Ministry of Health and Welfare, together with the Health Insurance Review and Assessment Service, announced on the 26th that it has established the '2025 Plan for Voluntary Inspection of Medical Institutions' and will sequentially conduct voluntary inspections of medical care benefit costs for seven items, including 'Discrepancies in the Purchase and Claim of Anti-Atherosclerotic Agents,' starting next month.

The voluntary inspection system is a system in which, when the Health Insurance Review and Assessment Service notifies medical institutions of items that may have been improperly claimed due to errors or other reasons, the medical institutions conduct self-inspections and voluntarily correct and improve improper or erroneous claims. Medical institutions that faithfully carry out voluntary inspections will have their unjust enrichment recovered, but on-site investigations and administrative sanctions will be exempted.

This year's voluntary inspection target items were selected through discussions by the 'Voluntary Inspection Operation Council,' which included participation from the medical and pharmaceutical sectors, totaling seven items. Accordingly, from March, the Ministry of Health and Welfare plans to notify medical institutions with a high likelihood of improper or erroneous claims for items such as pharmacies' 'Discrepancies in the Purchase and Claim of Anti-Atherosclerotic Agents (about 300 locations)' and 'Claims using biopsy FORCEPS after using resection FORCEPS (about 180 locations)' as targets for voluntary inspection.

Even if not subject to voluntary inspection notification, self-reporting of improper claims is possible through the Health Insurance Review and Assessment Service's medical institution work portal site, and in such cases, on-site investigations and administrative sanctions will also be exempted.