A nursing hospital that provided 'buffet-style' meals in a self-service format for hospitalized patients can receive national health insurance benefits, according to a court ruling.
According to the regulations on the criteria for long-term care benefits, care institutions must provide 'meals prescribed by a doctor' to hospitalized patients. The court determined that it cannot be concluded that a self-service format meal is not a doctor's prescribed meal.
The Seoul Administrative Court’s Administrative Division 1 (Chief Judge Director General Yang Sang-yoon) ruled in favor of the plaintiff, Mr. A, on Jan. 24, in his lawsuit seeking to cancel the Korea Health Insurance Corporation’s decision to recover long-term care expenses.
The Korea Health Insurance Corporation decided to recover 25,449,320 won that it paid to Mr. A's hospital in March 2023. The corporation conducted a local investigation at Mr. A's hospital in February and March 2021 and determined that 'the hospital improperly billed the meal expenses for hospitalized patients as long-term care expenses.'
The corporation raised concerns about the fact that Mr. A's hospital provided buffet-style meals to patients from September 2017 to February 2018. This is because the regulations for long-term care payments stipulate that 'to claim meal expenses for hospitalized patients, meals must be provided as prescribed by a doctor.'
In response, Mr. A filed this lawsuit in June 2023 to cancel the corporation's recovery decision. Mr. A argued that providing buffet-style meals was also providing 'meals to hospitalized patients in accordance with the Korean dietary intake standards as per a doctor's prescription.'
The court accepted Mr. A's claims. The panel stated, 'The corporation only claims that buffet-style meals are likely to result in imbalanced nutrient intake, therefore not a doctor's prescribed meal, without making any claims or proving what specific prescriptions should have been made and were not made by Mr. A's hospital.'
The panel further commented, 'Mr. A's hospital appears to have prescribed distinct treatments by allowing patients who need mobility assistance, patients requiring infection control, and patients experiencing difficulty in walking or with side effects to eat in their rooms, while only allowing other patients to use the buffet restaurant.' They added, 'It is difficult to view that it wasn't prescribed by a doctor just because the corporation claims that buffet meals are likely to lead to imbalanced nutrient intake.'