Court Upholds Full Recovery of COVID Home-Care Monitoring Fees

A Seoul court has upheld the National Health Insurance Service’s decision to recover all patient-management fees paid to a clinic that failed to meet monitoring requirements for people receiving COVID-19 treatment at home.

The Seoul Administrative Court ruled against the operator of an internal medicine clinic who sought to overturn the recovery order. The case concerned payments received while the clinic served as a designated home-treatment medical provider during the pandemic.

The clinic managed confirmed COVID-19 patients from February through April 2022. Guidance in force at the time required participating medical institutions to check each patient’s temperature, blood oxygen level and possible symptoms twice a day. The health insurance agency later concluded that the clinic had claimed management fees even though it conducted fewer than two checks on certain days.

In May last year, the agency ordered the clinic to repay 9,075,340 won. The clinic operator argued that the twice-daily standard applied only during the main treatment period, not on the first and final days of home care. The operator also contended that recovering the entire amount was excessive given the difficulties of caring for patients during a public-health emergency.

The court rejected both arguments. It said health monitoring, remote medical care and emergency response were central elements of the home-treatment program, and the rules could not be read as automatically exempting the first or last day of care from the twice-daily requirement.

The judges acknowledged that two checks might be difficult when a patient was assigned late in the afternoon or released from home treatment in the morning. However, they said an exception would require objective evidence showing that compliance was impractical in the specific circumstances. The court found that the materials submitted by the clinic were insufficient to establish such an exception.

The court also found the full recovery lawful. It characterized the measure as the return of improperly received benefits rather than an additional punitive charge. Under that reasoning, recovering the complete amount paid in violation of reimbursement standards was the proper remedy, and the agency had neither abused its discretion nor violated the principle of proportionality.

The decision clarifies that providers participating in emergency reimbursement programs remain responsible for documenting compliance with the conditions attached to public payments. It also indicates that practical obstacles may be considered, but only when a provider can support them with objective records tied to individual cases.