Investigation of False COVID-19 Medical Billing Expands Nationwide

All 12 Sampled Medical Institutions Confirmed for Fraudulent Claims
Expanded to Over 8,400 Medical Institutions Nationwide
"Recovery of Fraudulent Amounts Is Feasible"

The National Health Insurance authorities have decided to expand the investigation into medical institutions that falsely claimed COVID-19 related medical fees and received nursing care benefits to over 8,400 medical institutions nationwide.

According to the "Plan for Expanded Investigation Based on the Sample Survey Results of COVID-19 Medical Fees" submitted by the National Health Insurance Service (NHIS) to the office of Jeong Chun-sook, a member of the Health and Welfare Committee of the National Assembly from the Democratic Party of Korea, on the 25th, the NHIS will investigate whether there were improper claims of COVID-19 medical fees at 8,423 medical institutions nationwide from next month until June of next year. The types of medical institutions under investigation include 43 tertiary general hospitals, 257 general hospitals, 513 hospitals, and 7,610 clinics.

The reason the NHIS expanded the investigation to all medical institutions nationwide is due to the prediction that cases of improper claims are widespread. Last month, the NHIS revealed that "a sample survey conducted on 12 medical institutions suspected of false claims for COVID-19 medical fees from October 17 last year to March 28 this year found that all had improperly received nursing care benefits." The total amount of improper claims by these institutions was 953 million KRW.

In this investigation, the NHIS will review COVID-19 related medical cases at medical institutions from February 1, 2020, when the first COVID-19 case was confirmed, until June 30 of last year. This period covers when health insurance benefits were applied to COVID-19 vaccines, home treatment, diagnostic tests, and more.

Examples include separately claiming consultation fees on the day of COVID-19 vaccination or claiming home treatment patient management fees after only one phone monitoring session instead of the required two. They also plan to examine cases where rapid antigen test fees were falsely claimed for patients without COVID-19 symptoms such as fever.

Measures to recover funds from medical institutions confirmed to have improperly claimed COVID-19 medical fees are expected to be easier than with 'office worker hospitals.' Even if improper claims are detected, most medical institutions continue their practice because they consider the claimed amounts insignificant.

[Image source=Yonhap News]

An NHIS official stated, "Since medical institutions claim insurance benefits for related diseases while providing treatment, improper amounts can be offset there, making fund recovery easier." In fact, in the first sample survey, recovery measures were completed within a year for all 12 medical institutions.

From next month, the NHIS plans to first review the claims of targeted medical institutions through a computerized system to identify suspicious cases, then request explanations from those institutions to recover improper nursing care benefits related to COVID-19. A voluntary correction system allowing self-reporting of inappropriate claims will also be implemented. For suspicious medical institutions that do not participate, the NHIS will conduct on-site verification visits from December this year until June next year.

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