[Why&Next] NHIS Targets Clinics Run by Non-Physicians; Medical Community Objects to Special Judicial Police Powers

Passed by the Legislation and Judiciary Committee's bill subcommittee on Nov. 11
NHIS: "Investigations must be expedited to prevent losses to National Health Insurance finances"
KMA: "Giving the insurer compulsory investigative powers would be an ab

Opposition from the medical community is growing after a bill granting the National Health Insurance Service (NHIS) special judicial police authority (SJPA) passed a subcommittee of the National Assembly’s Legislation and Judiciary Committee. The NHIS says prompt investigations by special judicial police are necessary to eliminate illegally established institutions, such as hospitals run by unlicensed owners and pharmacies operating under borrowed licenses, and to prevent losses to health insurance funds. Medical associations, however, oppose the move, warning that giving the NHIS—which is both an insurer and the party responsible for recovering payments—compulsory investigative powers could lead to an abuse of authority and undermine the fairness of investigations.

On November 11, the first subcommittee of the National Assembly’s Legislation and Judiciary Committee reviewed and approved eight amendments to the Act on the Persons Who Perform the Duties of Judicial Police Officers and the Scope of Their Duties, which would grant SJPA authority to NHIS executives and employees. Concerns about the potential abuse of investigative powers were also raised in the subcommittee, which asked the NHIS to prepare safeguards before the full committee meeting on November 13.

The NHIS is pushing to introduce the SJPA because of limitations in the current investigative system. Because hospitals run by unlicensed owners are established using the names of doctors or pharmacists, it is difficult to identify their actual operators and trace the flow of funds. Under the current process, the NHIS conducts an administrative investigation and then refers the case to investigative authorities, which means it can take a considerable amount of time to begin an investigation and recover funds.

According to the NHIS, the number of illegally established institutions subject to recovery decisions rose from 50 in 2024 to 74 in 2025. The amounts subject to recovery decisions were 175,371,000,000 won and 107,743,000,000 won, respectively. Through September this year, recovery of 57,562,000,000 won had been ordered from 39 institutions. The NHIS says that obtaining investigative powers would help prevent illegal operators from hiding assets or fleeing and improve the effectiveness of fund recovery.

The medical community, however, takes issue with the fact that the NHIS is an interested party as an insurer, with authority to pay and recover insurance benefits. It argues that assigning the NHIS responsibility for compulsory investigations in addition to investigations and recovery would concentrate authority in one institution and could undermine the neutrality and independence of investigations. It also says it must be verified whether NHIS employees, who are private citizens rather than public officials, have sufficient investigative expertise and the ability to protect human rights.

The Korean Medical Association cited the fact that only about 4.9% of cases from the NHIS’s administrative investigations were referred to prosecutors with a recommendation to indict. Kim Taek-woo, president of the association, expressed concern: “If the NHIS, as a creditor, also takes charge of investigations, unrelated and excessive investigations could harm even medical institutions that are innocent. If the mere existence of suspicion leads to a suspension of benefit payments or to the suspension of operations or medical services, patients’ right to receive care will also be violated.”

The Seoul Medical Association also cited the lack of sufficient objective evidence that the NHIS’s special judicial police would be more effective than existing police investigations, as well as the lack of adequate independent external oversight, as reasons it opposes granting compulsory investigative powers. The association said, “The priority should be to strengthen verification when medical institutions are established and expand cooperation between the police and the medical community.”

As the dispute spread, the NHIS labor union also weighed in, directly criticizing the Korean Medical Association’s claims. In a statement, the union said, “The NHIS has accumulated decades of experience in paying and recovering medical care benefits and has health care big data and the ability to detect fraudulent claims.” It added, “With administrative investigations alone, it is impossible to trace accounts or conduct searches and seizures, giving illegal operators time to hide their assets.”

The union continued, “Self-regulation by the medical community can serve as a supplementary measure, but it cannot replace public investigative powers to uncover organized schemes involving the use of borrowed names and concealed funds.” It also said concerns about human rights violations could be reduced by establishing institutional safeguards, such as limiting the duties of special judicial police to crimes involving illegally established institutions and the lending of professional licenses, and guaranteeing the warrant requirement and the right to assistance from counsel.

The NHIS says it will fulfill its social responsibilities as an insurer in a manner commensurate with the expertise required for SJPA work and the urgency and seriousness of the issue. On November 10, NHIS President Kang Cheong-hee met with Lee Dong-wook, head of the Gyeonggi-do Medical Association, who had visited the NHIS to lodge a protest. Kang said, “To provide the public with good medical services, we need to create an environment in which medical professionals can treat patients with pride.” He promised, “We will put safeguards in place to address the medical community’s concerns about human rights violations and abuses of authority during the process of introducing the SJPA.”

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