"If You Undergo Surgery, We'll Refund Part of the Medical Fee" Hospitals Also Involved in Insurance Fraud

Reward of up to 50 million KRW for reporting insurance fraud

Insurance Fraud Illustration

[Asia Economy Reporter Changhwan Lee] #. Hospital A hired marketing staff responsible for attracting patients and recruited patients by saying, "We will ensure that real insurance claims can be received for cataract surgery and refund part of the medical expenses in cash." Afterwards, they issued excessive medical expense receipts after cataract surgery, enabling patients to receive excessive insurance payments, and returned part of the amount received as medical expenses to the patients, causing profits exceeding actual losses, which was detected as insurance fraud.

It has been revealed that some hospitals and clinics committed insurance fraud by making patients who underwent specific surgeries or procedures claim excessive insurance payments and returning part of the medical expenses.

According to insurance fraud response organizations such as the General Insurance Association, Life Insurance Association, Financial Supervisory Service, and National Police Agency on the 17th, as a result of operating the 'Cataract Insurance Fraud Special Reporting and Reward System' from April to June to strengthen investigations into cataract insurance fraud, 60 insurance fraud reports were received against 35 ophthalmology hospitals.

Looking at the types of crimes, there were 12 cases of excessive surgery (cataract), 10 cases of false hospitalization, 4 cases of false receipts, and 34 other cases. The others included patient inducement and brokerage by brokers, cash paybacks, provision of transportation and accommodation, etc.

Domestic insurance fraud is becoming increasingly serious. According to the National Police Agency, the number of insurance fraud (violation of the Special Act on Insurance Fraud Prevention) arrests and suspects increased from 1,193 cases and 2,658 people in 2017 to 3,361 cases and 11,491 people in 2021. Compared to 2017, the number of arrests in 2021 increased 2.8 times, and the number of suspects increased 4.3 times.

Recently, organized insurance fraud involving intentional accidents targeting vehicles violating regulations by recruiting conspirators online, and corporate brokers linked with hospitals have frequently occurred. The police also stated that there are cases of fraud linked to violent crimes such as murder aimed at insurance money, causing significant public concern.

The General Insurance Association and Life Insurance Association jointly announced with the Financial Supervisory Service that they will expand the scope of 'special insurance fraud reporting' targets from the existing cataract cases to problematic non-reimbursable treatments and extend the reporting period until the end of the year to eradicate insurance fraud and establish a sound insurance market order.

Problematic non-reimbursable treatments include HIFU, thyroid, manual therapy, cosmetic surgery, in addition to cataracts. The reporting reward has also been increased from a maximum of 30 million KRW to 50 million KRW.

To promote special reporting, the association emphasized that reports with clear insurance fraud suspicion and recognized seriousness will undergo separate review and part of the special reward will be paid in advance, and public promotion will be conducted in major areas of Seoul with high foot traffic (Gangnam, Gwanghwamun, etc.).

An association official said, "If you participate or become involved in insurance fraud activities by brokers who demand false medical certificates from medical institutions or offer monetary benefits, you can be criminally punished as an accomplice," and urged, "If you receive an insurance fraud proposal or become aware of suspicious cases, please actively report to the Financial Supervisory Service or the insurance company's insurance fraud reporting center."

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