Appeals against administrative dispositions
Preparation of written opinions for long-term care institutions, administrative appeals for business suspension, and review requests for reimbursement
If an on-site investigation by the National Health Insurance Service (NHIS) confirms improper claims or a violation of the staffing standards, a business suspension, an administrative fine and recovery of benefit costs can all be imposed at once. During a business suspension no benefit costs can be claimed at all, which leads directly to beneficiaries leaving and to problems with staff employment. The disposing authority and the appeal route differ for each disposition, so start by organizing the deadlines on the basis of each notice.
Procedure
- Appeal Difficulty High
Submitting an opinion, objection or administrative appeal against a disposition or decision already made, or applying for damage relief or dispute mediation. The reviewing body decides after examining the facts and the law, so preparing supporting evidence is important.
We will prepare the long-term care institution's prior notice opinion, business suspension administrative appeal request, and National Health Insurance Service (NHIS) recovery decision review request form. We distinguish between different dispositions and receiving organizations.
Scope & fee
- Response to advance notice
- We will write an opinion by reviewing the notice of suspension or recovery of business at 1 long-term care institution and the provided salary, personnel, and administrative data. Requests for administrative appeal and review after disposition are separate. Scope of writing: 1 type of prior notification opinion, 5 pages per page. It does not include in-office submissions.
- Documents to challenge business suspension
- We will review the local government's business suspension of 1 long-term care facility and the evidence provided, and prepare an administrative appeal request. Requests for review of the National Health Insurance Service (NHIS)'s recovery decision, objections to fines, and suspension of execution are separate. Scope of preparation: 1 type of administrative appeal request for business suspension, 5 pages per type. It does not include in-office submissions.
- Documents to challenge recovery of funds
- We will prepare a review request by reviewing the National Health Insurance Service (NHIS)'s recovery decision and provided claims, personnel, and service records of 1 long-term care institution. administrative appeal for local government business suspension and request for reexamination by the National Health Insurance Service (NHIS) are separate. Scope of preparation: Request for review of recovery decision, 1 type, 5 pages per type. It does not include in-office submissions.
1. Respond at the on-site investigation stage
Before you sign the written confirmation of the investigation results, check whether any part differs from the facts, and if it does, write down your opinion. Gather the benefit provision records, work schedules and care workers' attendance records for the same period as the scope of the investigation.
2. Classify the issues
Sort the case into claims for services not provided, claims made while a care worker was hospitalized or on leave, inflated service hours, or violation of the staffing standards. Also check whether it was a mistake or intentional, and whether the amount and the period were calculated accurately.
3. Submit a written opinion at the prior notice stage
When you receive a prior notice of business suspension or a notice of planned recovery, submit a written opinion and explanatory materials within the deadline stated in the notice (usually about 2 weeks). Calculation errors are sometimes corrected at this stage.
4. Administrative appeal for business suspension, objection for administrative fines
Against a business suspension disposition by the head of a city, county or district (si/gun/gu), you can file an administrative appeal within 90 days from the date you became aware of the disposition. An administrative fine is challenged not by an administrative appeal but by a written objection filed with the disposing authority within 60 days from the date you received the notice of imposition, and once an objection is filed the case goes to the court for trial. If you need to keep operating, apply for a stay of execution at the same time. Also review whether, depending on the grounds, you can request that the business suspension be replaced with a penalty surcharge.
5. Request for review to the NHIS against a recovery decision
Against an NHIS decision to recover unjust enrichment, file a request for review with the NHIS within 90 days from the date you became aware of the disposition, and if you do not accept the result you can go on to a request for re-review.
Required documents
- Opinion submission form (Enforcement Rule of the Administrative Procedures Act, Annexed Form No. 11), administrative appeal petition (Enforcement Rule of the Administrative Appeals Act, Annexed Form No. 30), and request for review (Enforcement Rule of the Long-Term Care Insurance Act, Annexed Form No. 32)
- Written confirmation of the on-site investigation results, prior notice and disposition notice, notice of planned recovery
- Long-term care benefit provision records, service contract for each beneficiary
- Care workers' work schedules and attendance records, proof of hospitalization and leave
- Staffing status and hiring and resignation materials
- Materials on corrective and recurrence prevention measures, internal checklists
- Materials on the institution's operating status (number of beneficiaries, number of staff, revenue)
Fees
There is no official fee for filing an administrative appeal or a request for review with the NHIS. Our office fee starts from the amount shown above and may vary depending on whether we handle the case from the written opinion stage and whether the business suspension and the recovery are challenged together; we will give you an exact quote after reviewing your documents.
Legal basis and review date
- Long-Term Care Insurance Act, Article 37
- Long-Term Care Insurance Act, Article 43
- Long-Term Care Insurance Act, Article 55
- Long-Term Care Insurance Act, Article 56
- Administrative Appeals Act, Article 27
- Act on the Regulation of Violations of Public Order, Article 20
Check these first
- The disposing authorities and appeal deadlines for business suspension and administrative fines on the one hand and for recovery on the other run separately, so manage the dates separately for each notice.
Frequently asked questions
By when must I challenge a business suspension disposition against a long-term care institution?
Is a recovery decision also challenged by an administrative appeal?
Are claims made while a care worker was hospitalized also recovered?
Are there cases where the business suspension period was reduced?
Can I pay a penalty surcharge instead of a business suspension?
Contact us
Hwang Yunsang Administrative Office in Songdo, Incheon prepares and submits administrative documents and explains the procedure. If your situation is similar, send us a message.
📍 2697, 26F POSCO Tower-Songdo, 165 Convensia-daero, Yeonsu-gu, Incheon, Republic of Korea · 📞 010-3374-2687 · 🌐 hwangadmin.com
This guide is general information based on public sources. Requirements, documents and deadlines differ by case and by the competent agency, so please confirm them before you proceed.