14 Cases Detected for Fraudulent Claims of 6.6 Billion KRW in Long-Term Care Benefits... Rewards Up to 131 Million KRW

NHIS Rewards 14 Informants Reporting Illegal Establishments Such as Office-Managed Hospitals

The National Health Insurance Service (NHIS) will pay a total reward of 466 million KRW to nine individuals who reported 14 medical institutions that falsely or fraudulently claimed medical treatment fees and other nursing care benefits.

On the 2nd, the NHIS announced that it resolved this decision at the '2024 2nd Health Insurance Reporting Reward Deliberation Committee' held on the 30th of last month.

The amount detected as false or fraudulent claims at the 14 institutions, reported by insiders and others, totals 6.61 billion KRW, and the highest reward amount to be paid according to the collection rate among the rewards decided on that day is 131 million KRW.

The reporter who will receive the highest reward reported a so-called 'Samu-jang Hospital' operated by a non-medical person employing medical personnel. It was revealed that this hospital was established and effectively operated by a dentist who rented out their medical license to open a clinic, even though only dental hospitals or dental clinics can be established, and claimed nursing care benefits amounting to 2.41 billion KRW from the NHIS, which were paid out.

The NHIS has introduced and implemented a reward system for reporting medical institutions that make fraudulent claims since 2005 to prevent leakage of health insurance finances. Related persons of medical institutions can receive up to 2 billion KRW, and general reporters such as users of medical institutions can receive up to 5 million KRW. Reports can be made through the NHIS website, mobile application (The Health Insurance), visits, or mail.

Namhoon Kim, Executive Director of Benefits at NHIS, said, "To eradicate the increasing false and fraudulent claims and the problem of Samu-jang Hospitals every year, continuous public interest and prompt reporting are most important," urging active interest and participation.

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