[Becoming an Insurance Insider] Hospitals and Clinics Committing Insurance Fraud by Luring Patients with 'Free Medical Treatment'

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[Asia Economy Reporter Oh Hyung-gil] Clinic A was found to have inflated patients' outpatient visits or issued fake medical certificates and receipts even though patients did not visit or receive treatment, enabling patients to claim indemnity medical insurance benefits, and the clinic was found to have defrauded health insurance benefits.

Clinic B was recently caught by financial authorities for colluding with brokers to lure and arrange illegal patients and abetting insurance fraud. Clinic B provided expensive herbal medicines not covered by insurance and issued false outpatient confirmation certificates despite patients not visiting or receiving treatment.

Twenty-five medical institutions that fabricated accident details or falsely admitted patients and fabricated diagnoses to commit insurance fraud were caught. The amount of damage reached a staggering 23.3 billion KRW.

The 'Public-Private Insurance Joint Investigation Council,' launched by the Financial Supervisory Service and the National Health Insurance Service together with the Insurance Association, uncovered a total of 23.3 billion KRW related to 25 medical institutions through joint insurance fraud investigations.

Among the 25 hospitals related to indemnity insurance fraud, 14 were hospitals, with the total amount detected at these hospitals reaching 15.8 billion KRW, accounting for 68% of the total.

This investigation also uncovered, for the first time, a fraud ring that conspired with multiple hospitals to lure patients illegally by signing 'patient referral contracts' disguised as promotional agency contracts. The broker organizations that continued insurance fraud through corporate medical advertising were found to have disguised themselves as legitimate 'medical advertising corporations' and colluded with multiple hospitals in insurance fraud.

Additionally, the most common type of insurance fraud was false hospitalization, found in 13 hospitals, with traditional Korean medicine hospitals and clinics being the most frequent among medical institutions. In particular, false hospitalization and excessive treatment for profit frequently occur in illegal medical institutions operated as 'office-owner hospitals.'

The scale of detection is expected to increase further. The council plans to promptly proceed with 50 ongoing investigations and continuously promote cooperation among related agencies.

A Financial Supervisory Service official warned, "If you are tempted by brokers offering financial benefits and participate in insurance fraud, you will be criminally punished as an accomplice," adding, "Brokers induce ordinary people to commit insurance fraud by recommending specific surgeries and issuing false medical receipts so that indemnity insurance and others can cover the costs."

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