Increasing Alveolar Bone Insurance Fraud, Don't Be Swayed by Temptations

Life Insurance and Dental Association Launch Awareness Promotion Campaign

[Source=Getty Images Bank]

[Asia Economy Reporter Ki Ha-young] #1. Mr. A, who only had implants placed, was told by dental hygienist B that he could receive surgery insurance benefits, so he obtained a medical certificate for implants accompanied by alveolar bone graft surgery. The dental hygienist wrote the medical certificate and arbitrarily affixed the attending doctor's seal. Mr. A received 6 million KRW in surgery insurance benefits for the alveolar bone graft surgery but was caught for fraud and forgery of documents and sentenced to a fine of 5 million KRW.

#2. Mr. C had a total of seven implants placed along with alveolar bone graft surgery. To receive more insurance money, Mr. C obtained medical certificates divided into four separate dates and received a total of 8 million KRW in surgery insurance benefits. As a result, Mr. C was caught for fraud and sentenced to a fine of 3 million KRW.

Recently, insurance fraud involving false claims for alveolar bone graft surgery related to implant placement has been increasing. Patients involved in such insurance fraud may also face criminal penalties and other disadvantages, so caution is required.

According to the life insurance industry on the 18th, the amount of insurance payouts for alveolar bone surgeries by the three major life insurance companies last year was 132.4 billion KRW, an increase of 5.1% compared to the previous year. Insurance payouts related to alveolar bone surgeries have been on the rise, with 101.4 billion KRW in 2017, 110.6 billion KRW in 2018, and 125.9 billion KRW in 2019. The number of alveolar bone surgeries also surged by 33.3%, from 90,000 cases in 2017 to 120,000 cases last year.

While technological advancements have contributed to the increase in alveolar bone surgeries, a major cause of the rise in insurance payouts is also attributed to recent insurance fraud, such as false claims for alveolar bone graft surgeries related to implant placement at some dental hospitals and patient referral, mediation, and inducement activities through brokers.

In particular, to receive more insurance money from their subscribed insurance, cases of insurance fraud have been reported, including ▲claiming false surgery insurance benefits for alveolar bone graft surgery when only implants were placed ▲dividing a single day's alveolar bone graft surgery into multiple dates for claims ▲false claims for alveolar bone fractures after implant procedures due to periodontal disease ▲false or excessive claims by brokers and unfair demands such as rebates (paybacks, commissions).

Patients also may not recognize the seriousness of insurance fraud related to implants and other daily life matters and can be involved in insurance fraud, facing criminal penalties and other disadvantages. If medical consumers or dental hospital personnel are involved in acts like those mentioned above, they may be subject to imprisonment of up to 10 years or fines up to 50 million KRW under the Special Act on the Prevention of Insurance Fraud, and imprisonment of up to 3 years or fines up to 30 million KRW under the Medical Service Act.

The insurance industry is conducting guidance and promotional campaigns with the Korean Dental Association to reduce insurance fraud related to alveolar bone. An industry official said, "Insurance fraud related to alveolar bone causes relative deprivation among most honest dentists who operate clinics normally and may lead to the misconception that they are part of an unethical group." He added, "We will continue to work on institutional improvements and promotions through collaboration to establish a fair medical market order and a proper medical culture in the future."

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