New regulations on recovering medical examination and treatment costs under health insurance

The Lao Dong Newspaper Legal Consulting Office replied:

Article 52 of Decree No. 188/2025/ND-CP stipulates the recovery of health insurance examination and treatment costs as follows:

1. The recovery of health insurance medical examination and treatment costs is carried out for medical examination and treatment costs that have been paid by health insurance but are discovered to be not in accordance with the provisions of law through inspection, examination, auditing, settlement of problems, handling of law violations by competent authorities and detection during the implementation process.

2. Based on the conclusion and handling results of the competent authority as prescribed in Clause 1 of this Article, the director of the social insurance agency shall issue a document to recover the cost of medical examination and treatment under the health insurance under his authority. The recover document must clearly state the legal basis for recovery, the content of the violation, the amount recovered, the recovery period, and the responsibilities of organizations and individuals related to the recovered costs. Medical examination and treatment facilities are responsible for returning the recovered funds to the Health Insurance Fund.

3. The recovered funds will be accounted for in the year of recovery.

4. Medical examination and treatment facilities have the right to recommend the social insurance agency to reconsider the recovery of health insurance medical examination and treatment costs or recommend the competent authority to consider and resolve them according to the provisions of law.

5. In case the recovery of health insurance medical examination and treatment costs in the work of inspection, examination, auditing and handling of law violations by competent state agencies has provisions other than this Article, it shall be applied according to that provisions.

Thus, the recovery of medical examination and treatment costs under health insurance is regulated as above.