Seven Key Areas of Health Insurance Claim Errors to Be Intensively Inspected at Hospitals and Pharmacies

Ministry of Health and Welfare to Implement Self-Inspection for Medical Institutions in 2026

The Ministry of Health and Welfare announced on January 22 that, together with the Health Insurance Review and Assessment Service, it has established the "2026 Self-Inspection Implementation Plan for Medical Institutions" and will begin its full-scale implementation starting this month.

The self-inspection system is a policy in which medical institutions are notified in advance of items with a high likelihood of improper health insurance claims, allowing them to review their own claims and correct any errors. The core aim is to encourage voluntary improvement by correcting mistakes in advance, rather than imposing administrative sanctions.

For hospitals, clinics, and pharmacies that faithfully carry out self-inspections, any improper gains will be recovered, but for the items inspected, on-site investigations and administrative sanctions will be waived.

This year, the inspection targets were selected through discussions with the "Self-Inspection Operations Council," which includes representatives from the medical community. The seven items are: "Claims exceeding the recognized number of daily living activity tests," "Discrepancies between purchase and claim of contrast agent injections," "Discrepancies between purchase and claim of local anesthetic injections," "Errors in night-time dispensing fees and other night-time surcharges," "Errors in claims for intravenous bolus injections," "Discrepancies between purchase and claim of herbal benefit medications," and "Duplicate claims for each stage of denture treatment."

The Ministry of Health and Welfare plans to notify hospitals, clinics, and pharmacies with a high likelihood of improper claims regarding these items as the target institutions for self-inspection.

Even if a medical institution does not receive a self-inspection notice, it can voluntarily report any improper claims it discovers through the HIRA work portal and receive the same exemption from on-site investigations and administrative sanctions.