Broker arranging cataract patients with 'Silsunboheom' insurance arrested and indicted... Gangnam ophthalmology clinic director also facing trial

The brokers who referred cataract patients insured under indemnity insurance to hospitals and pocketed kickbacks, along with the director of an ophthalmology hospital in Gangnam, Seoul, who commissioned them, have been brought to trial.

They disguised themselves as promotional agencies or hospital staff on paper and received referral fees amounting to 20-30% of the surgery cost, which was about 1.5 million KRW per patient or approximately 5 million KRW for one eye. Some brokers earned as much as 2.4 billion KRW over a period of about three years.

Seoul Central District Prosecutors' Office, Seocho-dong, Seoul.
Photo by Choi Seok-jin

In October last year, after the police transferred the case involving two brokers, the prosecution conducted a full-scale reinvestigation, including account tracking and raids on the hospital director who denied the charges, and uncovered the broker gang.

The Criminal Division 2 of the Seoul Central District Prosecutors' Office (Chief Prosecutor Kwon Yoo-sik) announced on the 22nd that broker So Mo (36) was arrested and indicted on charges of violating the Medical Service Act, and five other brokers along with Park Mo (49), the director of A Ophthalmology Hospital, and two other hospital officials were indicted without detention.

According to the prosecution, So is accused of signing a patient referral contract disguised as a promotion and marketing service contract with Hospital A from October 2019 to March last year and receiving about 2.4 billion KRW in referral fees. Other brokers were found to have earned between 170 million KRW and 560 million KRW in a similar manner.

It was found that Hospital A paid a total of 4 billion KRW to them as referral fees from October 2019 to July this year.

Since its opening, Hospital A paid brokers 1.5 million KRW per patient or 20-30% of the cataract surgery cost in cash as referral fees, disguising the brokers as advertising agents or employees to make the payments appear as legitimate expenses.

The "monofocal intraocular lens" used in cataract surgery treatment, which is an artificial lens focused on either distant or near vision, is covered by the National Health Insurance, but the "multifocal intraocular lens," a special lens designed to focus on distant, near, and intermediate distances, is known to be a non-reimbursable item with a considerably high surgery cost.

They exploited the fact that indemnity insurance subscribers diagnosed with cataracts could receive up to 100% reimbursement for surgery costs involving the insertion of a multifocal intraocular lens according to their insurance contract, mainly introducing patients in their late 40s to 70s who had indemnity insurance to the hospital and pocketing referral fees.

Hospital A conducted high-cost cataract surgeries eligible for indemnity claims on these recruited patients, generating annual sales of 23.8 billion KRW in 2020, 30.1 billion KRW in 2021, and 21.2 billion KRW last year, ranging between 20 billion and 30 billion KRW per year.

A prosecution official stated, "Since the costs are reimbursed by indemnity insurance, there is a perception that patients do not suffer losses, leading to patient referral crimes committed without guilt. We will make every effort to maintain the prosecution and recover criminal proceeds so that the defendants receive punishments commensurate with their crimes."

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