When a person receives an insurance benefit by means of deception or other wrongful conduct, the insurer may collect all or part of the amount of the benefit from the person.
偽りその他不正の行為によって保険給付を受けた者があるときは、保険者は、その者からその給付の価額の全部又は一部を徴収することができる。
In the case referred to in the preceding paragraph, if the insurance benefit is granted because the employer made a false report or certificate, or because a physician providing health insurance treatment as prescribed in Article 64 at a medical institution providing services covered by health insurance as prescribed in Article 63, paragraph (3), item (i) or an attending physician as prescribed in Article 88, paragraph (1) has made a false entry on the medical certificate to be submitted to the insurer, the insurer may order the employer, physician providing health insurance treatement, or attending physician to pay the money to be collected pursuant to the preceding paragraph jointly and severally with the person who received the insurance benefit.
If a medical institution providing services covered by health insurance or a pharmacy providing services covered by health insurance as prescribed in Article 63, paragraph (3), item (i) or a designated home-nursing provider as prescribed in Article 88, paragraph (1) receives, by means of deception or other wrongful conduct, any payment of expenses relating to benefits for medical treatment or any payment pursuant to the provisions of Article 85, paragraph (5) (including when applied mutatis mutandis to Article 85-2, paragraph (5) or Article 86, paragraph (4)), Article 88, paragraph (6) (including when applied mutatis mutandis to Article 111, paragraph (3)) or Article 110, paragraph (4), the relevant insurer may cause the medical institution, pharmacy, or designated home-nursing provider to refund the amount so paid and to pay, in addition, an amount obtained by multiplying the amount to be refunded by four-tenths.
保険者は、第六十三条第三項第一号に規定する保険医療機関若しくは保険薬局又は第八十八条第一項に規定する指定訪問看護事業者が偽りその他不正の行為によって療養の給付に関する費用の支払又は第八十五条第五項（第八十五条の二第五項及び第八十六条第四項において準用する場合を含む。）、第八十八条第六項（第百十一条第三項において準用する場合を含む。）若しくは第百十条第四項の規定による支払を受けたときは、当該保険医療機関若しくは保険薬局又は指定訪問看護事業者に対し、その支払った額につき返還させるほか、その返還させる額に百分の四十を乗じて得た額を支払わせることができる。