FSS: "If Insurance Fraud is Suspected, We Will Strengthen Review"

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[Asia Economy Reporter Changhwan Lee] The Financial Supervisory Service (FSS) will strengthen scrutiny of suspected insurance fraud cases to prevent insurance payout leakage caused by excessive medical treatment.

On the 27th, the FSS announced that it plans to revise the "Model Guidelines for Preventing Insurance Fraud" to prevent insurance payout leakage and implement the revisions next month.

The revision includes the establishment of five basic principles and investigation procedures for selecting insurance accident investigation targets.

The five principles are ▲ refusal to submit treatment evidence ▲ decreased credibility ▲ unclear purpose of treatment or hospitalization ▲ irrational pricing ▲ medical institutions suspected of excessive treatment.

If these conditions are met, the FSS plans to investigate whether the insurance payout reasons apply by securing additional evidence for disease treatment and consulting medical experts.

In cases of disputes with consumers, compensation decisions will be made after judgment by a third medical institution, and suspected insurance fraud cases will be referred for investigation and other measures.

The criteria for selecting insurance accident investigation targets will be disclosed on insurance companies' websites and separately notified to policyholders and others.

Furthermore, to protect consumers, it has been made mandatory to pay delayed interest in cases of delayed payment for legitimate insurance claims. When insurance payouts are reduced or denied, the reasons and procedures for damage relief must also be provided.

An FSS official emphasized, "We will continue to actively protect consumers' rights for legitimate insurance claims," adding, "We will strengthen supervision over insurance claims arising from excessive medical practices with insurance fraud factors to ensure that the benefits of National Health Insurance and indemnity insurance coverage are fairly distributed to the majority of the public."

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