[Anchor]

The National Health Insurance Service has been continuing its lawsuits against companies that collected health insurance benefits after supplying only half of the Achilles tendon required for patient transplants. Recently, a court overturned the first-instance ruling in the appeal, siding with the NHIS and ordering the companies to return the health insurance benefits they improperly received.

This is an exclusive report by Reporter Kim Minjun.

[Reporter]

[Park Myung-un / Former Head of the 2nd International Crime Investigation Division at the Seoul Metropolitan Police Agency: (When the cruciate ligament) is ruptured, this Achilles tendon is needed to connect the torn part, but they cut it in half and transplanted it into the patient's body.]

Three years ago, police announced that 85 people, including company representatives, had been massively apprehended on charges of illegally pocketing 10 billion won by importing half-sized Achilles tendons without approval from the Ministry of Food and Drug Safety, supplying them as if they were "complete" Achilles tendons, and applying for health insurance benefits based on the "complete" products.

However, based on the MFDS's stance that "there is no need to receive separate import approval just because it is half-sized," the investigation ended with "no charges," and the NHIS also lost the first instance of a damages lawsuit filed demanding the return of the improperly collected health insurance benefits.

Following an exclusive SBS report last January highlighting this issue, the MFDS even sent an official document to the companies instructing them to "clearly notify whether it is a half-piece so that illegal reception issues do not occur." Last month, however, the verdict in the second-instance damages lawsuit was overturned.

The court first paid attention to the fact that, according to NHIS notices, half-sized Achilles tendons are managed under a separate code from complete ones and have different upper price limits.

Regarding the MFDS's stance, which had influenced the police investigation and the first-instance ruling, the court drew a line by stating that they are "agencies with different purposes" and that "it is difficult for the health insurance benefit fraud case of the NHIS to be swayed by whether or not there was separate import approval from the MFDS."

The court rebuked the companies, stating, "In light of the purpose of the health insurance system, which aims to provide the maximum welfare benefits to as many citizens as possible with limited finances, this is an act with a high degree of culpability," and ordered them to compensate approximately 236.9 million won for the difference in health insurance benefits.

[Choi Jung-gyu / Attorney for the Public Interest Whistleblower: (The police) investigation fizzled out, but (I think) criminal punishment must be carried out so that such attempts, which threaten public health, will never happen again.]

While some companies have appealed to the Supreme Court, the NHIS's request for a reinvestigation filed with the police last February is also expected to gain rapid momentum following the second-instance ruling.

(Camera: Kang Dong-chul | Video Editing: Lee Sang-min)