342 People Involved in Medical Record Fraud for Insurance Caught in Cheonan, Chungnam

A total of 342 medical personnel and others were caught embezzling insurance money worth 2.3 billion KRW by manipulating or inflating medical records.

The Chungnam Provincial Police Agency announced on the 29th that they arrested 342 individuals, including 3 doctors and 20 nurses from three women’s hospitals located in Cheonan, 4 insurance planners, and fake patients, on charges of violating the Special Act on the Prevention of Insurance Fraud.

Among those arrested, A (49), the head of the hospital counseling office who actively planned the crime and recruited patients, was detained.

According to the police, A conspired with insurance planner B to lead the crime.

First, they exploited the fact that patients who received uterine fibroid laser treatment (HIFU) could claim insurance payments ranging from 7 million to 10 million KRW.

They recruited fake patients, manipulated medical records to make it appear as if they had undergone HIFU treatment, claimed insurance money, and then split the actual insurance payout between the hospital and the patients at a 6 to 4 ratio.

Additionally, it was confirmed that they manipulated medical records a total of 8,378 times by changing treatment details for skin care and various women’s procedures, which are not covered by indemnity insurance, to diagnoses eligible for indemnity insurance coverage (such as manual therapy).

During the course of A and others’ crimes, medical staff at the three hospitals were found to have largely been aware of the manipulation of medical records and receipts but tolerated the crimes to boost hospital revenue.

In particular, it was confirmed that one hospital doctor fabricated records to make it appear as if hospital employees received treatment in shifts, thereby receiving medical benefits from the National Health Insurance Service.

Separately, the police are conducting additional investigations after detecting circumstances where, over one year starting in 2020, 10 pregnant women underwent abortion surgeries, but false stillbirth certificates were issued and fetal remains were entrusted to disposal contractors.

The Chungnam Provincial Police Agency stated, “Insurance fraud undermines the financial soundness of both private and public insurance and increases the premium burden on honest policyholders, making it a harmful crime closely related to daily life. The police will continue to crack down on insurance fraud and respond strictly to prevent any damage.”

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