Beware of Real Loss Insurance Fraud Lured by Broker Organizations

"If You Claim Insurance with False Medical Records, You Will Also Face Criminal Penalties"

[Asia Economy Reporter Park Sun-mi] Housewife C, who is well acquainted with hospital officials, conspired to receive commissions by introducing patients to hospitals and introduced and referred subscribers of indemnity health insurance to hospitals. The court, judging this as insurance fraud, ultimately regarded C as a patient recruiter and sentenced her to 1 year and 6 months in prison (with a suspended sentence).

On the 25th, the Financial Supervisory Service issued a consumer alert at the 'caution' level, stating that medical personnel and related parties involved in insurance fraud conspired with corporate broker organizations are receiving heavy punishments from judicial authorities.

The broker organizations disguise themselves as legitimate corporate activities and illegally recruit patients on a large scale through social network services (SNS), putting insurance consumers at very high risk of being involved in insurance fraud.

If consumers comply with the broker's inducement and referral and claim indemnity health insurance benefits with false documents, they are considered accomplices in insurance fraud and may face criminal penalties and other disadvantages. Criminal penalties under the Special Act on the Prevention of Insurance Fraud include imprisonment of up to 10 years or fines of up to 50 million won.

Consumers should be especially careful not to obtain false medical certificates or other documents from hospitals to claim insurance benefits. They must not manipulate claims by receiving treatments not covered by indemnity health insurance and then claiming for covered treatments, or falsify the dates and inflate the number of actual tests or surgeries performed. If offered insurance fraud proposals or if suspicious cases are discovered, they should actively report to the Financial Supervisory Service or the insurance company's insurance fraud reporting center.

A Financial Supervisory Service official stated, "We will continue to actively support investigations into insurance fraud conspired by broker corporations and hospitals," adding, "We plan to strengthen investigations and detections of organized insurance fraud in cooperation with related agencies and strictly impose related administrative sanctions."

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