(Health Korea News / Lee Chang-yong) Regarding media reports that “Regarding the medical bill claim from Medical Institution A that removed a benign tumor on the vulva, the Health Insurance Review & Assessment Service requested before and after surgery photos,” the Health Insurance Review & Assessment Service explained, “Photos are just one of several requested documents that the medical institution can choose from; they are not documents that must be submitted.” They emphasized that the content of the report was exaggerated and different from the facts, distorting the purpose of the request for submission of documents.
On the 25th, the Health and Welfare Service announced in a press release, “Among Representative A’s claims from November 2023, both Ja-406-2(a) vulvar tumor excision surgery and Ja-14(a) benign skin tumor excision surgery were claimed for benign neoplasm of the vulva,” explaining, “It is rare for two surgeries to be claimed at the same time.”
Accordingly, the Health and Welfare Service stated, “We requested reference materials for review such as the initial consultation record, progress record, and surgical record from Hospital A, and as a result of the review by referring to the outpatient progress record (including the confirmation of tissue examination results) and procedure record submitted by the medical institution, it was confirmed to be an abscess, not a vulvar tumor, and therefore it was recognized as Ja-405 Badrin gland abscess excision, not ‘Ja-406-2 (a) Vulvar tumor excision and Ja-14 (a) Benign skin tumor excision.’”
However, according to the arbitration board, Representative A claimed the same type of medical expenses several more times after that, and was reviewed, most recently in July 2024, he claimed the same type of illness and surgery fees as above.
According to the current National Health Insurance Act, a medical institution that wishes to claim medical care benefits must file a claim for medical care benefit cost review with the Health Insurance Review & Assessment Service, and the Health Insurance Review & Assessment Service must promptly notify the Corporation and the medical institution of the review results. The Health Insurance Review & Assessment Service may also request submission of documents such as resident registration, immigration control, medical records, and pharmaceutical supplies in order to evaluate the appropriateness of medical care benefits for the medical care fee review claimed by the medical institution. In addition, the Health Insurance Review & Assessment Service may request submission of documents necessary for the review of medical care benefit costs.
In accordance with these regulations, the Health Insurance Review & Assessment Service requested that Representative A submit sufficiently provable materials, including a progress record, anesthesia record, surgical record, pre- and post-operative photos, and tissue pathology test results, to conduct an accurate and fair review of medical care benefits costs.
However, the judging panel’s position is that the purpose of the request for data was distorted and reported in a way that could mislead readers.
An official from the Health Insurance Review & Assessment Service said in a phone call with Health Korea News on the 25th, “The documents we requested from Representative A were for the scope of verifiable data, and we did not necessarily request before and after surgery photos as reported in the media,” adding, “Since the same type of medical fee review was being conducted, we requested the documents to correct any errors.”
The official added, “On July 24, we sufficiently explained the purpose of the request for materials and the scope of verifiable materials to Director A through a landline phone call so that he could fully understand,” and “It is the responsibility of the Health Insurance Review & Assessment Service to conduct a fair medical fee review.”
The arbitration board stated that it will continue to strive to provide prompt responses and guidance on the correct method of claiming when making inquiries related to future evaluations.
Earlier, on the 25th, private news agency Newsis reported in an article titled “Health Insurance Review & Assessment Service: “Send photos” to an obstetrician/gynecologist who performed surgery on a female disease,” that “The Health Insurance Review & Assessment Service, which reviews medical expenses at hospitals and clinics, has sparked controversy by requesting an obstetrician/gynecologist to submit photos of female patients who had benign tumors removed from major body parts.”
According to reports, Director B of Obstetrics and Gynecology Clinic A in Gangnam-gu, Seoul posted on Facebook on the 23rd, “The Health Insurance Review & Assessment Service is asking female patients who had benign vulvar tumors removed to send photos of their genitals without their consent,” and “I protested this, but they are being silent. Where should I report this?”
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Source: www.hkn24.com
