Prosecution Deferred for Receiving Large Insurance Payouts with False Medical Records... Constitutional Court: "Not Fraud, Disposition Must Be Canceled"

Chief Justice Yoo Nam-seok of the Constitutional Court and the justices are waiting for the start of the constitutional review ruling on the unconstitutionality confirmation constitutional complaint regarding the "Announcement of the Korea-Japan Comfort Women Issue Agreement" held on the 27th at the Constitutional Court in Jongno-gu, Seoul. Photo by Kang Jin-hyung aymsdream@

[Asia Economy Reporter Kim Hyung-min] Despite receiving treatment while commuting between home and hospital, the Constitutional Court has ruled that the case involving the receipt of a large amount of insurance money based on falsified medical records falsely stating that the patient was hospitalized and treated cannot be recognized as fraud.

On the 15th, the Constitutional Court announced that it unanimously decided to cancel the disposition in a constitutional complaint case filed by Mr. A and others, who received a suspension of indictment on fraud charges, claiming that "the suspension of indictment by the prosecution violated their right to equality and pursuit of happiness." A suspension of indictment means the case is not brought to trial but the charges are effectively considered guilty. Although the prosecution acknowledged Mr. A's charges, stating they were not severe enough to bring to trial, the Constitutional Court concluded that this judgment was incorrect.

From January 2016 to February 2017, Mr. A and others received outpatient treatment, including ultrasound examinations. However, the medical records submitted to the insurance company were problematic because they were recorded as if inpatient treatment, which has a higher insurance payout rate, had been received. According to the insurance policy terms that Mr. A and others subscribed to, outpatient medical expenses are compensated up to 200,000 KRW, while inpatient medical expenses can be compensated up to 90% of the total cost.

The prosecution investigated whether Mr. A and others submitted falsified documents to the insurance company to receive more compensation than actual and issued a suspension of indictment. In response, Mr. A and others filed a constitutional complaint requesting the cancellation of this decision, arguing that they had no intent to commit fraud against the insurance company but still received a suspension of indictment.

The Constitutional Court stated, "Mr. A and others did not request that the time of examination be recorded as inpatient treatment in the medical records, nor is there any evidence that they were involved in the recording of the medical records." It added, "It is believed that non-physicians like Mr. A and others would have found it difficult to recognize that such medical record entries could be false," and "There is no evidence that Mr. A and others attempted to fraudulently obtain insurance money during the process of maintaining the insurance contract for at least about three years."

This content was produced with the assistance of AI translation services.