全民健保特約藥局藥事服務費核扣之法律界限—以藥師未親自執行業務為例【本期企劃】 試閱
The Legal Boundaries of Fee Recoupment for NHI-Contracted Pharmacies: A Case Study on the Pharmacist' s Duty to Personally Perform Services
本文以近期指標性判決（人和藥局案）為核心，探討全民健保特約藥局因藥師未親自執行業務遭核扣費用之法律界限。過去司法實務多採「全有全無」之僵化解釋，認為調劑行為不可分割，任一環節違規即全額追扣，常在特殊場域（如監獄）引發違反比例原則及公法上不當得利之爭議。本研究分析發現，司法實務已在程序與實體面向發生典範轉移。程序上，法院釐清「費用核扣通知」性質為契約上之意思表示，確立以一般給付訴訟取代撤銷訴訟，開啟對契約履行程度進行實質審查之大門。實體上，法院揚棄傳統行政制裁思維，引入民法「不完全給付」法理，將核扣性質由「懲罰」轉化為「對價平衡」與「損害填補」。透過解構健保支付標準之成本結構，司法實務成功將藥事服務內涵量化為可獨立評價之對價單元。法院據此確立比例核扣之審查基準，拒絕僅因附隨義務違反即剝奪全部給付。此發展顯示行政法院已從對行政機關判斷之尊讓，轉向高密度之契約解釋與事實認定，直接介入給付金額之量化分析，對於落實行政契約之實質對等與量化正義，具有深遠意義。
Centering on the recent landmark judgment of the Renhe Pharmacy case, this article explores the legal boundaries regarding fee recoupment imposed on National Health Insurance (NHI) contracted pharmacies arising from a pharmacist’s failure to personally perform professional duties. Historically, judicial praxis adhered to a rigid “all-or-nothing” interpretation, viewing pharmaceutical dispensing as an indivisible act wherein any procedural breach justified total fee recoupment. This approach frequently engendered controversies regarding violations of the principle of proportionality and public law unjust enrichment, particularly within specialized settings such as correctional facilities.This study posits that a paradigm shift has occurred within judicial jurisprudence across both procedural and substantive dimensions. Procedurally, courts have recharacterized the “notification of fee deduction” as a contractual declaration of intent rather than an administrative disposition, thereby establishing the action for general performance—rather than the action for revocation—as the appropriate procedural vehicle. This reorientation has paved the way for substantive scrutiny regarding the degree of contractual performance. Substantively, courts have abandoned the traditional administrative sanction paradigm in favor of incorporating the Civil Code doctrine of “incomplete performance.” Consequently, the legal nature of fee recoupment has transformed from a punitive measure into a mechanism for preserving the equilibrium of consideration and effecting compensatory restitution. By deconstructing the cost structure inherent in the NHI fee schedule, the judiciary has successfully quantified pharmaceutical services into discretely evaluable units of consideration. Accordingly, courts have established a standard of review for proportional recoupment, rejecting the total forfeiture of payment predicated solely on the breach of ancillary obligations. This evolution signifies a departure by the Administrative Court from judicial deference toward administrative discretion, moving instead toward a rigorous mode of contract interpretation and fact-finding. By directly intervening in the quantitative analysis of payable amounts, this judicial trend holds profound implications for actualizing substantive equality and quantitative justice within the regime of administrative contracts.
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