요양기관 현지조사의 행정법적 검토

Abstract

The administrative investigation into the medical institutions is an administrative investigations of the Minister of Health and Welfare, by which whether reimbursement for costs and copayments, etc. received on the basis of detailed medical history review is unjust should be confirmed and inspected, and by which administrative penalties on the result of unjust enrichment and restitution will be imposed on the local medical institutions. Article 84, paragraph 2 National Health Insurance Act(NHIA) and paragraph 2 of Article 32 Act of Medical Provisions provides this administrative investigation into the medical institutions. This administrative investigation into the medical institutions with the nature of powerful administrative investigation has legal limits on the Framework Act on administrative investigation and the limit of legal procedures. The basic rights of health professionals can be interfered by this administrative investigation into the medical institutions. To protect this rights relevant legislations which include the protection of the rights of examinee must be performed. Nevertheless, these realities are practically governed by the Guidelines on Administrative Investigation into the medical institutions. Therefore, the biggest problems of the Administrative Investigation into the Medical Institutions consist in its deficiency of legal basis, its insufficiency of delegated legislation and the inadequacy of the investigation procedures based on the principle of due process of law. In addition, the abuse of investigating authority of government officials, excessive issue of sanctions will be solved by the follow-up legislation which provides a detailed site investigation regarding the procedures. In order to resolve the legal issues of the Administrative Investigation into the Medical Institutions at this time it will be necessary to arrange each laws to to meet the intent of the Framework Act on administrative investigations. These medical institutions, the administration of local research on the administrative investigation will be necessary to separate maintenance decree. Local medical institutions, major contents and procedures for the Administrative Investigation into the Medical Institutions will be provided in the National Health Insurance Act and Medical Provisions Act, and the contents which should be specified in the presidential decree must be clearly provided.