75 Million Won in Rewards for 11 Whistleblowers Reporting False or Improper Health Insurance Claims

National Health Insurance Service Uncovers 550 Million Won in Improper Claims at Nine Medical Institutions

The National Health Insurance Service announced on December 9 that it will award a total of 75 million won in rewards to 11 individuals, including 10 employees who reported improper claims for medical care benefits at nine hospitals and clinics, as well as one whistleblower who reported a case of health insurance card misuse.

The National Health Insurance Service previously convened the 'Second Health Insurance Reporting Reward Review Committee for 2025' on December 3 and made this decision.

The total amount uncovered in this round of false or improper claims was 550 million won, with the highest individual reward being 21 million won.

For example, at Hospital A, residents from other institutions and doctors affiliated with the Ministry of National Defense were made to treat emergency room outpatients during weekday nights, Saturdays, and holidays. The hospital then falsified records to make it appear as if its own physicians had provided the care, fraudulently receiving 150 million won in medical care benefit payments.

At Hospital B, a physical therapist who had not completed training in Voita or Bobath therapy administered central nervous system developmental rehabilitation to patients and then improperly claimed and received 120 million won in specialized rehabilitation treatment fees.

The health insurance reporting reward system was introduced in 2005 to prevent financial losses in the health insurance fund by eradicating various forms of false and improper claims. The maximum reward for individuals affiliated with healthcare institutions is 2 billion won, while general informants can receive up to 5 million won.

Reports of improper claims by healthcare institutions can be submitted through the National Health Insurance Service website or the 'The Health Insurance' application. Reports can also be made in person or by mail. The identity of whistleblowers is strictly protected under the Public Interest Whistleblower Protection Act.

Kim Namhun, Executive Director of Benefits at the National Health Insurance Service, emphasized, "In order to eradicate increasingly sophisticated false and improper claims, as well as the issue of 'paper hospitals,' it is essential for conscientious employees and just citizens to remain vigilant and report promptly."

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