"1.9 Billion KRW Fraudulent Nursing Care Benefits"…22 Health Insurance Fraudulent Claim Nursing Institutions Disclosed

Published on the Ministry of Health and Welfare website from 12 PM on the 10th for 6 months

[Asia Economy Reporter Ki Ha-young]#. A nursing institution fraudulently claimed 194.62 million KRW in nursing care benefits over 36 months, obtaining undue profits. Although no actual patients visited and no medical treatment was received, the institution falsely claimed consultation fees as if treatment had been provided. Ultimately, A nursing institution was reported for fraud under the Criminal Act, along with recovery of undue profits, a 190-day suspension of operations, and public disclosure measures in accordance with the National Health Insurance Act.

The Ministry of Health and Welfare announced on the 10th that it will publicly disclose the list of nursing institutions that falsely claimed health insurance nursing care benefits on the Ministry’s website and other platforms.

The disclosure period is from 12:00 noon on the day of the announcement until August 9, lasting six months. A total of 22 institutions were disclosed this time for false claims: 11 clinics, 3 dental clinics, 7 Korean medicine clinics, and 1 Korean medicine hospital. The total amount falsely claimed by these institutions is approximately 1.18244 billion KRW.

The disclosed information includes the name, address, and type of nursing institution; the name of the representative (or head of the medical institution if a corporation), gender, license number; the violation details; and the administrative sanctions imposed.

The list will be posted on the websites of the Ministry of Health and Welfare, Health Insurance Review & Assessment Service, National Health Insurance Service, relevant metropolitan cities, provinces, special autonomous provinces, cities, counties, districts, and public health centers.

The health insurance disclosure system was introduced following the amendment of Article 100 of the National Health Insurance Act on March 28, 2008. Institutions subject to disclosure are those nursing institutions that have been administratively sanctioned for falsifying or forging related documents to falsely claim nursing care benefits, as decided through deliberation and resolution by the 'Health Insurance Disclosure Review Committee.' Institutions subject to disclosure are those with false claims amounting to 15 million KRW or more, or where the false claim amount accounts for 20% or more of the total nursing care benefit costs.

Since the system was implemented in February 2010, a total of 450 institutions have been publicly disclosed for false claims: 12 hospitals, 12 nursing hospitals, 220 clinics, 37 dental clinics, 8 Korean medicine hospitals, 144 Korean medicine clinics, and 17 pharmacies.

Lee Sang-hee, Director of the Insurance Evaluation Division at the Ministry of Health and Welfare, stated, "We will continuously strengthen on-site investigations of institutions suspected of false or improper claims and strictly enforce administrative sanctions against those caught. In particular, for institutions that falsely claim benefits, we will rigorously implement criminal prosecution and separate disclosure measures in addition to suspensions of operations and other sanctions."

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