Financial Services Commission Holds 'Insurance Investigation Council' Meeting... "Promoting Measures to Prevent Insurance Fraud"

Confirmed Insurance Fraud Conviction to Prompt Automatic Cancellation of Insurance Agent Registration

[Asia Economy Reporter Jin-ho Kim] Financial authorities plan to share information on defaulters who operate manager hospitals and do not refund health insurance benefits after being penalized, and to automatically cancel the registration of insurance agents who have received final judgments for insurance fraud.

On the 29th, the Financial Services Commission held an 'Insurance Investigation Council' together with the Ministry of Health and Welfare, the National Police Agency, the Financial Supervisory Service, and the National Health Insurance Service to review trends in insurance fraud and discuss countermeasures. The participating organizations agreed that insurance fraud and excessive non-reimbursable medical treatments threaten the foundation of indemnity insurance, which serves as a private medical safety net, and decided to devise active measures.

First, information on defaulters who owe health insurance benefit refunds will be shared in the second half of this year. The National Health Insurance Service plans to provide credit information agencies with data on defaulters who were detected and penalized for operating manager hospitals or pharmacies with borrowed licenses and who have yet to refund health insurance medical benefits. The Financial Services Commission plans to restrict financial transactions such as loans for defaulters penalized for opening manager hospitals, thereby blocking their re-entry into the medical business.

If an insurance agent is confirmed to have received a sentence of a fine or higher for insurance fraud, their registration will be canceled without procedures such as investigation, sanctions, or hearings. Additionally, the number of unjust enrichment recovery lawsuits filed to reclaim insurance payments will be publicly disclosed separately from insurance claim and payment lawsuits.

Recently, the issue of some ophthalmology hospitals excessively claiming indemnity insurance payments after non-reimbursable cataract surgeries was also discussed. It was problematic that patients were induced to enroll in indemnity insurance on the condition of partial refund of medical fees, and that the cost of multifocal lenses for vision correction, a non-reimbursable item, was excessively charged.

In response, the Financial Services Commission plans to explore various non-reimbursable management measures with health authorities to recognize the professionalism of medical practices while enabling medical consumers to bear costs reasonably.

In the second half of the year, the Financial Services Commission will closely monitor the latest trends in insurance fraud through the 'Insurance Investigation Working Group.' It will also promote effective insurance fraud prevention measures such as expanding information sharing on insurance fraud among related agencies, conducting joint investigations on insurance fraud linking public and private sectors, and sharing investigation techniques.

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