Regulations Governing Contracting and Management of the National Health Insurance Contracted Medical Care Institutions Article 39
The Insurer may suspend the contract for one to three months if the contracted medical care institution has any of the following circumstances during the term of the contract. Notwithstanding, in the case of contracted hospitals, the Insurer may suspend the medical department or specific service item that violates the requirement or the outpatient inpatient services in whole or in part for one to three months in accordance with the seriousness of the violation.1. Declaration of medical expenses incurred by non-beneficiaries in the name of beneficiaries;2. Provision of medications, nutrient supplements, or other items not necessary for treatments to beneficiaries, registration of unnecessary medical services, and declaration of medical expenses;3. Falsifying medical expenses by forging medical records with no diagnosis or treatment rendered;4. Other unscrupulous behavior or false certifications, reports, or statements in order to declare medical expenses; or5. Retention of personnel who are not qualified physicians to provide medical services for beneficiaries and declaring medical expenses by the contracted medical care institution.
中文原文 全民健康保險醫事服務機構特約及管理辦法第39條
保險醫事服務機構於特約期間有下列情事之一者，保險人予以停約一個月至三個月。
但於特約醫院，得按其情節就違反規定之診療科別、服務項目或其全部或一部之門診、住院業務，予以停約一個月至三個月：
一、以保險對象之名義，申報非保險對象之醫療費用。
二、以提供保險對象非治療需要之藥品、營養品或其他物品之方式，登錄就醫並申報醫療費用。
三、未診治保險對象，卻自創就醫紀錄，虛報醫療費用。
四、其他以不正當行為或以虛偽之證明、報告或陳述，申報醫療費用。
五、保險醫事服務機構容留未具醫師資格之人員，為保險對象執行醫療業務，申報醫療費用。
但於特約醫院，得按其情節就違反規定之診療科別、服務項目或其全部或一部之門診、住院業務，予以停約一個月至三個月：
一、以保險對象之名義，申報非保險對象之醫療費用。
二、以提供保險對象非治療需要之藥品、營養品或其他物品之方式，登錄就醫並申報醫療費用。
三、未診治保險對象，卻自創就醫紀錄，虛報醫療費用。
四、其他以不正當行為或以虛偽之證明、報告或陳述，申報醫療費用。
五、保險醫事服務機構容留未具醫師資格之人員，為保險對象執行醫療業務，申報醫療費用。