Whether the introduction of special judicial police (SJP) authority for the National Health Insurance Service (NHIS) will gain momentum following President Lee Jae-myung's directive has emerged as a top concern for the medical community.
On Tuesday, the Korean Medical Association (KMA) expressed deep anger at NHIS President Jeong Ki-seok's remarks during a New Year press conference indicating his intent to pursue the SJP system, demanding immediate withdrawal of the proposal.
"The introduction of SJP has raised concerns about potential abuse of authority, and even the National Assembly is proceeding cautiously," the KMA said in a statement. "The NHIS is bypassing proper procedures by providing misleading information during presidential briefings and attempting to illegitimately obtain undue authority."
The association added, "Granting SJP authority to NHIS employees would inevitably lead to expansion of the organization's powers and size. We cannot help but question whether this is the NHIS's true intention behind pushing this initiative." The KMA argued that establishing SJP would be highly inappropriate as it would cause serious overlapping abuse of administrative and investigative powers.
"Following the 2022 NHIS employee embezzlement case, the organization has been revealed as a main culprit of health insurance fiscal leakage due to chronic mismanagement including excessive labor cost budgeting and embezzlement," the KMA said. "The NHIS should worry about becoming an SJP investigation target itself. Blocking fiscal leakage would be better achieved by utilizing existing police personnel with investigative experience and expertise rather than introducing SJP."
The KMA's logic is that contrary to the NHIS's claims of expedited investigations, this would inevitably lead to shoddy investigations. If not-guilty verdicts are later rendered, the already-executed fund recoveries and payment holds would have to be returned to medical institutions with interest, potentially worsening health insurance finances.
"The NHIS is a party that enters fee contracts with medical institutions and holds stakeholder status in paying and reducing medical fees. If compulsory investigation authority is added, medical institutions would be subordinated to a vertical supervisory relationship beyond their contractual party relationship with the NHIS," the association warned. "This would seriously dampen physicians' legitimate treatment rights and generate defensive medicine."
The KMA continued, "Serious human rights violations and breaches of the warrant principle have been reported regarding the discretionary investigation authority exercised through what is called 'on-site verification.' If compulsory investigation authority is granted to NHIS employees, unprofessional investigation practices due to lack of human rights awareness and legal knowledge, and resulting abuse of public authority and infringement of citizens' fundamental rights will become more severe." The association emphasized the high likelihood of abuse for the financial purpose of debt collection, unlike investigative agencies.
President Lee ignited the debate late last year during a Ministry of Health and Welfare briefing by asking, "Is it true that SJP authority would enable catching fake patients?" At the time, NHIS President Jeong answered affirmatively, stating, "The NHIS has requested SJP authority for a long time. Without the system, referrals to investigators take an average of 11 months."
When President Lee asked about necessary personnel, Jeong replied, "Starting with about 40 people would suffice. Since we already have investigation staff, we just need the SJP designation." President Lee quipped, "If we give you SJP authority, catch them well."
At the New Year press conference on Monday, President Jeong said, "The president directly instructed this three times and it was even broadcast live, so I think it will happen and we are preparing." He emphasized, "When investigations begin on illegally established institutions, they immediately divert their accounts so there's nothing to recover. With SJP introduction, the NHIS can immediately examine accounts and find illegal institutions, reducing harm to the public."
Press conference materials highlighted the positive functions of SJP introduction, including "shortened investigation periods," "NHIS expertise," and "ability to conduct focused investigations on illegal establishments," along with explanations that the system is necessary to protect legitimate medical institutions and establish proper medical order.