59 Million Won in Rewards Paid to 16 Whistleblowers Reporting National Health Insurance Fraud

NHIS Selects Whistleblowers Reporting Fraudulent Claims by Medical Institutions and Misuse of Health Insurance Cards

#A Dental Clinic received 50 million won by fraudulently claiming health insurance benefits for implant procedures performed on patients aged 65 and older, using non-insurance-covered prosthetic materials instead of the insurance-covered prosthetic material (PFM) eligible for reimbursement. The National Health Insurance Service (NHIS) has decided to pay a reward of 11 million won to the dental staff member who reported this case.

#Foreigner B fraudulently used the foreign registration number of another foreigner, C, who was eligible for health insurance, to receive medical treatment and other services, thereby obtaining 8.9 million won in National Health Insurance benefits. The whistleblower in this case will receive a reward of 1.7 million won.

The National Health Insurance Service announced on the 20th that it will pay a total of 59 million won in rewards to 16 whistleblowers who reported healthcare institutions and others for submitting false or fraudulent claims for reimbursement.

The NHIS previously reached this decision during the '2026 1st Health Insurance Reporting Reward Review Committee' held on May 15, where it reviewed cases involving 11 healthcare institutions, one quasi-healthcare institution (a self-catheter sales outlet), and four other related incidents. The total amount detected as improper claims reached 350 million won.

The highest reward amount approved was 11 million won, which was granted for the case where non-insurance-covered prosthetic materials were used instead of insurance-covered prosthetics in implant procedures for patients aged 65 and older, and fraudulent claims for reimbursement were submitted.

The health insurance reporting reward system was introduced and implemented in 2005 to prevent financial losses to the health insurance fund by eradicating various forms of false and fraudulent claims. Previously, the maximum reward was 2 billion won for healthcare institution insiders and 5 million won for other general whistleblowers, but since December last year, the ceiling has been raised to 3 billion won for all types of whistleblowers to encourage active reporting.

Improper claims by healthcare institutions can be reported through the NHIS website or the Health Insurance 25 app, as well as in person at branch offices or by mail. The identity of whistleblowers is thoroughly protected under the Public Interest Whistleblower Protection Act.

Kim Namhun, Executive Director of Reimbursement at the NHIS, stated, "In order to eliminate the increasingly sophisticated false and fraudulent claims and the issue of unauthorized 'office manager hospitals,' it is essential for conscientious workers and responsible citizens to remain vigilant and report promptly." He urged, "Please continue to show active interest and participate in public interest reporting."

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