Insurers Report 5 Gangnam Eye Clinics to Fair Trade Commission for Unfair Solicitation of Cataract Patients

[Asia Economy Reporter Ki Ha-young] Non-life insurance companies have reported hospitals suspected of abusing indemnity medical insurance related to cataract surgery to the Fair Trade Commission.

According to the insurance industry on the 29th, five non-life insurers including Samsung Fire & Marine Insurance, Hyundai Marine & Fire Insurance, DB Insurance, KB Insurance, and Meritz Fire & Marine Insurance reported five ophthalmology clinics located in Gangnam with a high proportion of cataract surgeries to the Fair Trade Commission on suspicion of "unfair customer inducement" under the Fair Trade Act.

The insurers believe that the five ophthalmology clinics paid patient referral fees to brokers to recruit cataract surgery patients and provided patients with exemptions or discounts on out-of-pocket expenses prohibited by the Medical Service Act, such as reimbursements (paybacks) for lodging, transportation, and partial surgery fees.

These hospitals paid brokers a commission of 1 million KRW per surgery patient or 5% of the surgery fee plus VAT. They also provided benefits by reimbursing patients who were referred with amounts ranging from 300,000 to 500,000 KRW under the names of lodging and transportation expenses. This may constitute unfair customer inducement prohibited under Article 23, Paragraph 1, Item 3 of the Fair Trade Act.

The insurance industry suspects that these ophthalmology clinics encouraged surgeries with false diagnoses even when cataracts were not severe or not present at all. Unnecessary cataract surgeries can cause health disadvantages to patients and may result in serious side effects. The cost of multifocal cataract surgery varies by medical institution, but the five Gangnam-based ophthalmology clinics subject to the report typically charge between 4.6 million and 5 million KRW per eye.

The amount of indemnity insurance payments related to cataract surgery has surged in recent years. Based on ten insurance companies selling personal indemnity insurance, last year’s indemnity insurance payments related to cataract surgery amounted to 637.4 billion KRW, a 50.8% increase compared to the previous year. In the first half of this year, the amount also increased by 58.2% year-on-year to 481.3 billion KRW.

A representative from the non-life insurance industry pointed out, "The unfair practices of some ophthalmology hospitals threaten local medical institutions and the public’s right to health, causing leakage in health insurance and indemnity insurance."

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