Whistleblower Reporting "Illegal Office-Managed Hospital" to Receive 91 Million Won Reward

NHIS, Decision by Committee on Rewards for Reporting Fraudulent Claims in Care Institutions
Reward Payment of 240 Million KRW Approved for 25 Whistleblowers

[Asia Economy Reporter Choi Dae-yeol] An employee of the medical institution who reported an illegal office-managed hospital will receive a reward of 91 million KRW.

According to the National Health Insurance Service on the 25th, at the first reward review committee meeting of this year held the previous day for reporting fraudulent claims by medical institutions, it was decided to pay a total of 240 million KRW in rewards to 25 whistleblowers. Twenty-five institutions were caught through tips from internal workers and others, and the total amount of fraudulent claims was found to be 5.2 billion KRW. The committee determines the reward amount by considering the type of whistleblower and the amount recovered in accordance with relevant regulations.

An office-managed hospital refers to a method where a non-medical office manager, who does not have the qualifications to establish a medical institution, hires a doctor to open a nursing hospital and effectively operates the hospital. This is illegal. There are significant concerns about the decline in the quality of medical services, and the possibility of health insurance finances leaking due to fraudulent and false claims is high.

At the committee meeting, the highest reward was given to an employee of a Korean medicine hospital, where a non-medical planning director put a doctor forward as the hospital director and operated the hospital from December 2014 to August 2016, during which 850 million KRW was fraudulently claimed. At another clinic, colluding with patients who intended to claim indemnity insurance, false medical records were created showing patients who had never been hospitalized even for a day were admitted daily and received manual therapy. The clinic received 58 million KRW over about two and a half years. The whistleblower will receive a reward of 12 million KRW.

A hospital was also caught for fraudulently claiming additional fees by reporting a specialist who worked at a comprehensive health screening center and concurrently served as a long-term care facility attending physician as an intensive care unit specialist. There were also places where unqualified individuals performed physical therapy and radiography. To prevent such incidents, the health authorities introduced and have been operating a reward system since 2005. Until now, the reward limit was 1 billion KRW, but the law was recently amended to allow up to 2 billion KRW starting next month.

Kang Cheong-hee, Executive Director of Benefits at the National Health Insurance Service, said, "The methods of illegal and fraudulent claims have become more diverse, making detection difficult, but detailed reports from internal workers are significantly contributing to protecting health insurance finances."

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