National Health Insurance Act

In order to review medical bills as entrusted pursuant to the provisions of Article 45, paragraph (5), a Federation whose district covers the area of a prefecture (excluding any such Federation that has not been joined by two-thirds or more of the prefectures or Municipalities, or Societies within its district) shall have a National Health Insurance Medical Fees Review Committee (hereinafter referred to as the "Review Committee").

A Federation may, as far as not hindering the carrying out of the affairs set forth in the preceding paragraph, have the Review Committee conduct the review of medical bills to be conducted as entrusted pursuant to the provisions of Article 76, paragraph (5) of the Health Insurance Act.

The Review Committee shall be composed of committee members representing health insurance-covered physicians and health insurance-covered pharmacists, committee members representing the prefecture and the Municipalities and Societies within the prefecture (hereinafter referred to as "insurers"), and committee members representing the public interest, as specified by the prefectural governor.

Committee members are to be commissioned by the prefectural governor, and the number of committee members is to be the same, respectively, for committee members representing health insurance-covered physicians and health insurance-covered pharmacists and committee members representing insurers.

Committee members representing health insurance-covered physicians and health insurance-covered pharmacists and committee members representing Insurers must be commissioned pursuant to the preceding paragraph based on recommendations made by concerned organizations in each category.

When the Review Committee finds it necessary in order to review medical bills, it may, upon the approval of the prefectural governor, request the relevant Health Insurance-Covered Medical Institution, etc. or the relevant office providing designated home-nursing to make a report or submit or present medical records or other books and documents, or may request any of the establishers or administrators of such Health Insurance-Covered Medical Institution, etc., the designated home-nursing provider, or any of the health insurance-covered physicians or health insurance-covered pharmacists who are in charge of medical treatment at such Health Insurance-Covered Medical Institution, etc. to appear or provide an explanation.

The Federation must pay travel expenses, daily expenses and accommodation expenses to any person who appeared at the Review Committee pursuant to the provisions of the preceding paragraph; provided, however, that this shall not apply to any person who appeared in response to a request for appearance issued due to defective or misleading entries in medical bills or medical records or other books and documents submitted by the relevant Health Insurance-Covered Medical Institution, etc. or the relevant office providing designated home-nursing.

In addition to what is provided for in this Chapter, necessary particulars concerning the Review Committee shall be prescribed by Ordinance of the Ministry of Health, Labour and Welfare.