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Controversy over excessive claims for insurance related to traffic accident patients continues.
The Health Insurance Review and Assessment Service (HIRA) is entrusted with insurance companies to examine whether medical institutions have excessive or false treatment. Although it is for the public interest, there are conflicts with medical institutions because the review is coercive.
Correspondent Kim Kwan-jin reported.
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An oriental medicine clinic in Gyeongsangbuk-do.
Standing behind the staff at the reception desk and giving orders, he sat down and directly handles the PC of the oriental clinic.
He can also be seen plugging a USB into a PC right next to him.
The Health Insurance Review and Assessment Service staff are copying the internal data of the oriental clinic.
[Director of Oriental Clinic: I went out to eat (in the meantime), but I tried this by plugging in a USB.
Personal information and important data should not be overlooked, so please give me my consent…
.]
Since 2013, the HIRA has been conducting a local verification review to make sure that medical institutions do not make false or unreasonable claims for car insurance medical expenses.
It is a commissioned business that receives commissions from auto insurance companies.
Although it is for the public interest, there are often conflicts with lawmakers during the investigation process, and lawmakers even sue the HIRA for obstruction of business.
[Director of Oriental Clinic: After about 10 minutes, the HIRA will notify you of the investigation…
He is staring at the patient from the side of the curtain, looking through the gap that looks like this, and is in a semi-nude state...
.]
When he said he would get help from a lawyer during the investigation, he sometimes made pressured comments.
[Health Insurance Review and Assessment Service A staff member: Very unpleasant.
We feel threatened by the lawyer.]
[Health Insurance Review and Assessment Service B staff: When a lawyer comes and does this, not only the center director but also the judges will always accompany them.
I think it could be a little tighter.]
According to the internal guidelines, the HIRA stated that it is proceeding to observe the treatment after receiving the data with the consent of the head of the medical institution and the patient.
She also explained that she is reviewing without prior notice only when there is a concern about the concealment or destruction of data by lawmakers, and that the participation of lawyers is guaranteed.
However, other situations are also taking place at some screening sites.
Unlike on-site inspections for health insurance, where procedures are strictly regulated according to the Administrative Investigation Act, it seems that the on-site verification of automobile insurance follows only the internal guidelines of the HIRA.
[Jeong-Hoon Kim / Attorney: Procedures such as the Basic Administrative Investigation Act, etc. or procedures equivalent to those must be stipulated in the law, and local confirmation and examination must be conducted accordingly...
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(Video coverage: Seol Min-hwan, Video editing: Ha Seong-won)