A prefecture may recommend to the Municipality concerned that it cancel all or part of the insurance benefits, if, despite the prefecture having made a request for re-examination, that Municipality does not cancel all or part of the insurance benefits relating to the request for re-examination, and the prefecture finds that those insurance benefits were provided in violation of the provisions of this Act or other relevant laws and regulations, or improperly (excluding where the examination based on the request for re-examination was conducted by the National Health Insurance Medical Fees Review Committee prescribed in Article 87, paragraph (1) (including, where a Federation of National Health Insurance Associations has, pursuant to the provisions of Article 45, paragraph (6), entrusted affairs concerning the review of medical bills to a corporation designated by the Minister of Health, Labour and Welfare prescribed in that paragraph (hereinafter referred to as a "Designated Association"), the person who conducts the review of those medical bills), or by the Review Committee prescribed in Article 19, paragraph (1) of the Act on the Medical Information Infrastructure and Medical Fee Examination and Payment Organization or the special Review Committee prescribed in Article 24, paragraph (1) of that Act).
都道府県は、再審査の求めをしたにもかかわらず、当該市町村が当該再審査の求めに係る保険給付の全部又は一部を取り消さない場合であつて、当該保険給付がこの法律その他関係法令の規定に違反し、又は不当に行われたものと認めるとき（当該再審査の求めに基づく審査が第八十七条第一項に規定する国民健康保険診療報酬審査委員会（第四十五条第六項の規定により国民健康保険団体連合会が診療報酬請求書の審査に係る事務を同項に規定する厚生労働大臣が指定する法人（以下「指定法人」という。）に委託した場合において、当該診療報酬請求書の審査を行う者を含む。）又は医療情報基盤・診療報酬審査支払機構法第十九条第一項に規定する審査委員会若しくは同法第二十四条第一項に規定する特別審査委員会において行われたときを除く。）は、当該市町村に対し、当該保険給付の全部又は一部を取り消すべきことを勧告することができる。
In making the recommendation under the provisions of the preceding paragraph, the prefecture must in advance hear the opinion of the Municipality concerned.
都道府県は、前項の規定による勧告を行うに当たつては、あらかじめ、当該市町村の意見を聴かなければならない。
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