A Medical Foundation and Its Doctor in Charge Were Disqualified as a Contracted Health Insurance Institution and a Health Insurance Doctor Due to Multiple Illegal Practices
The plaintiffs, the medical foundation A (which operated the clinic K) and doctor B (the director of clinic K), sued the defendant C (Okinawa Social Insurance Bureau) and claimed that the decision of their disqualification as contracted health insurance providers should be illegal. According to investigations, the plaintiff overstated the medical expenses, didn’t give patients their prescriptions, and made untruthful medical records to swindle money from health insurance. But the plaintiffs thought that the administrative procedures were not fully implemented before the penalty of disqualification, and that they were compelled to admit the truth. However, the court ruled that the defendant had given administrative guidance, carried out investigations and conducted hearings, but during these processes the plaintiffs still failed to give reasonable explanations for themselves. Therefore, it was legitimate for the defendant to determine the plaintiff has a significant misconduct and disqualified them as insurance providers according to health insurance law 80. The plaintiffs lost.