The Insurer shall inform insurance medical care institutions to make improvements for any of the following circumstances:
1. Failure to register insurance certificates and upload medical data of insurance beneficiaries in accordance with the Regulations Governing the Medical Services Covered under National Health Insurance.
2. Failure to assist insurance beneficiaries in applying for the coverage by labor insurance for occupational diseases and accidents and the subrogation right under the compulsory automobile liability system by issuing the necessary receipts or assisting in filing.
3. Non-purposeful errors in data filed for the survey of medicine prices.
4. Other non-major breach of the terms and conditions of the franchise contract.

The Insurer may impose one contract-violation point to the insurance medical care institutions for any of the following circumstances:
1. Patient transfer not conducted in accordance with medical laws or laws and regulations in relation to the National Health Insurance;
2. Violation of Articles 10 to 14, Articles 16 to 17, Article 25, Paragraph 2 of Article 32, Article 33 or Article 34;
3. Failure to audit the medical papers of insurance beneficiaries in accordance with the Regulations Governing the Medical Services Covered under National Health Insurance. Notwithstanding, the above may not apply to the case where the NHI IC card is later submitted for inspection after emergency treatment is given.
4. Failure to return the medical expenses paid by insurance beneficiaries at their own expenses, as stipulated by the Regulations;
5. Failure to charge insurance beneficiaries the fees they shall pay at their own expenses or declare medical expenses, as stipulated by the Regulations;
6. Improper solicitation of patents for accepting medical services covered by the insurance and such behavior penalized by the health competent authority;
7. Improper request for difference payment from a beneficiary with the difference exceeding the maximum benefit set by the Insurer;
8. In violation of Article 73 of the Act; or
9. Failure to rectify the situation within the deadline set forth by the Insurer.

The Insurer may deduct ten times of the reported medical expenses by the insurance medical care institutions based on the average total value of the most recent quarter of their locations should the insurance medical care institutions be found under any of the following circumstances:
1. Failure to provide medical services according to prescriptions, medical history or other records;
2. Provision of medical services without diagnoses from physicians;
3. Prescriptions or medical expenses reported not recorded in medical history or records;
4. Failure to produce medical history or records to facilitate the reporting of medical expenses;
5. Declaration of medical expenses knowing that patients use insurance certificates of others;
6. Retention of personnel who are not qualified medical personnel to conduct medical personnel’ s duties other than those of physicians;
The Insurer may directly deduct the medical expenses payable to the insurance medical care institutions for the abovementioned deductions.

The Insurer shall suspend the contract for one month if the insurance 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 which violates the requirement, or the outpatient, inpatient services in whole or in part for one month in accordance with the seriousness of the violation.
1. Violation of Article 68 or Paragraph 1 of Article 80 and again after three disciplinary actions by the Insurer;
2. Violation of Article 36 and subject to the punitive measure of three contract-violation points and the same violation again;
3. One of the subparagraphs in the preceding article after medical expenses being deducted three times;
4. Refusal to provide appropriate medical services to insurance beneficiaries and such offense being significant;

The Insurer may suspend the contract for one to three months if the contracted insurance 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 which 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; or
5. Retention of personnel who are not qualified physicians to provide medical services for beneficiaries and declaring medical expenses by the contracted medical care institution.

The Insurer shall terminate the contract if the contracted insurance medical care institution has any of the following circumstances. Notwithstanding, in the case of contracted hospitals, the Insurer may suspend the medical department or specific service item which violates the requirement, or the outpatient, inpatient services in whole or in part for one year in accordance with the seriousness of the violation.
1. Insurance medical care institutions or their responsible medical personnel has been suspended pursuant to the preceding Article and the same offence was found within five years after the completion of such suspension;
2. Unscrupulous behavior or false certifications, reports or statements to declare medical expenses and such offense being significant;
3. Violation of medical laws and regulations, and practicing licenses revoked by the competent health authority;
4. The contracted insurance medical care institution retains personnel who are not qualified physicians to provide medical services for beneficiaries and declare medical expenses, which is deemed as a serious violation.
5. Reporting of false dates in order to declare the expenses for medical services rendered to insurance beneficiaries during the period when the contract is suspended; or requesting other insurance medical care institutions to declare such expenses;
6. Contract terminated or suspended for a year pursuant to the above subparagraphs 1-5, and aforesaid offenses found within one year of resumed contracting after the previous contract termination or suspension of the contract.
No application for contracting is permitted within one year after the termination of the contract pursuant to the preceding paragraph.

Where the Insurer has imposed disciplinary actions on the contracted insurance medical care institution which has the conduct set forth in Paragraph 1 of Article 81 of the Act pursuant to Subparagraphs 2 and 4 of Paragraph 1 of the preceding article, the Insurer shall publicize the name of the institution, the name of the responsible medical personnel or the person committing the violation as well as the facts of the violation on its website between the issuance of the disciplinary letter and the termination of the disciplinary actions.

Where the suspension or termination of a contract pursuant to Articles 38 to 40 poses a threat of significant impact on the beneficiaries’ right to receive medical care, or is necessary to prevent or mitigate risks to the public, the contract insurance medical care institution, subject to the Insurer’s approval and within the scope of disciplinary, may apply to the Insurer for the deduction of the payment to offset the suspended or terminated contract period according to the declared volume of the medical department or specific service item which is subject to the disciplinary actions or the outpatient, inpatient services in whole or in part as well as the verified average points of the total volume of the district of the most recent year.
The preceding paragraph governing contractual suspension or termination is applicable to the pending cases not yet implemented before the effect data of the Regulations on September 15, 2010.

Significant offenses referred to in Subparagraphs 2 and 4 of Paragraph 1 of Article 40 of any of the following circumstances:
1. Falsely reported points exceed 100,000 and the provision to insurance beneficiaries with medicine, nutrient supplements or other items that are not medically necessary.
2. Falsely reported points exceed 100,000, the collection of insurance certificates and the false declarations of medical records and medical expenses for insurance beneficiaries not treated.
3. Falsely reported points exceed 150,000 and false declarations of hospital stay of insurance beneficiaries.
4. Falsely reported points exceed 250,000

If the operations of insurance medical care institutions are suspended by the competent health authority as a result of the violation of medical care laws and regulations, the contract shall be suspended during this period. If the operations of insurance medical care institutions are terminated or relocated, the contract shall be terminated. However, this does not apply to the situations whereby a notice has been sent to the Insurer with changed practicing licenses of the same insurance medical care institution moving to another address in the same township, district or city.

Contract shall be terminated should insurance medical care institutions be found under either of the following circumstances:
1. Violation of medical care laws and regulations, the practicing licenses were accordingly revoked by the health competent authority.
2. Subparagraph 2 or Subparagraph 3 of Paragraph 1 of Article 5.

Article 37 to 40 may not apply in the event that the contracted insurance medical care institution voluntarily reports to the Insurer of any incorrect information in its filed declaration or confesses to other authorities by returning the relevant expenses (or deductions) prior to the inspection visit conducted by the Insurer or other agencies. The same shall apply to the responsible medical personnel or the medical personnel liable for the conduct who have the above circumstance.

For any insurance medical care institution whose contract is suspended or terminated, the responsible or liable medical personnel shall not be reimbursed for the services of medical services they provide to insurance beneficiaries during suspension or within one year after termination.
The medical personnel whose expenses are not reimbursed are deemed to be subject to the disciplinary act of contract suspension or termination.

If insurance medical care institutions do not accept the disciplinary actions taken by the Insurer pursuant to the Regulations, they may request in writing for a second review within thirty days after they have received the notice. However, such request can only be made once.
The Insurer shall revisit the pending case within thirty days after the aforesaid application has been received. They shall change or rescind the original decision if the reason is justified.