Rapid Increase in Alveolar Bone Insurance Fraud... Joint Awareness Campaign by Life Insurance Industry and Dental Association

[Asia Economy Reporter Oh Hyung-gil] The Life Insurance Association announced on the 16th that it will conduct an educational publicity campaign on alveolar bone insurance fraud using dental insurance targeting 13,000 dental hospitals nationwide in cooperation with the Korean Dental Association.

Recently, insurance fraud has occurred at some dental hospitals, such as false claims for alveolar bone grafting related to implant surgery or patient introduction, mediation, and inducement through brokers.

Alveolar bone grafting corresponds to bone graft surgery, classified as a type 2 surgery in the Life Insurance Standard Terms and Conditions surgery classification table, and pays about 2 million KRW in surgical insurance benefits.

However, there is a method of abusing the terms that pay surgical insurance benefits per surgery by issuing false medical certificates claiming that surgeries on adjacent teeth performed on the same day were done over several days, thereby claiming insurance benefits multiple times.

The amount of insurance benefits paid by life insurance companies for alveolar bone surgeries has been increasing annually, from 101.4 billion KRW in 2017 to 132.3 billion KRW last year. The number of investigations by investigative agencies targeting dental hospitals is also increasing.

Patients caught for insurance fraud should be cautious as they may face criminal penalties and other disadvantages. Under the Special Act on the Prevention of Insurance Fraud, they may be sentenced to up to 10 years in prison or fined up to 50 million KRW, and under the Medical Service Act, up to 3 years in prison or a fine of up to 30 million KRW.

The Life Insurance Association and the Korean Dental Association plan to distribute educational official letters and informational posters and collaborate on system improvements to establish order in the medical market and promote a proper medical culture.

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