"Opposed Medical School Expansion... Doctor Inflating Medical Fees Caught Red-Handed by Patient"

False Claims of Inflated Medical Fees for Health Insurance Premiums Reported
Patients Collect Evidence and Report to Authorities
"Some Doctors' Selfish Behavior Causes Public Suffering"

A specialist at a hospital located in Gwangju, Gyeonggi Province, has been reported for fraudulently inflating medical fees and improperly claiming health insurance premiums, Yonhap News reported on the 4th. The evidence was collected and reported by patients who had been treated at this hospital.

The hospital administered an injection only to the patient's left shoulder but recorded in the medical records that injections were given to both shoulders and claimed insurance fees accordingly.
[Photo by Yonhap News]

The doctor treated patient A from April to August last year for spinal nerve therapy, administering anesthesia injections three times to one shoulder, but when billing the National Health Insurance Service, the doctor recorded treatment as if both shoulders had been treated. The same method was applied to other patients. In August last year, the doctor treated only one shoulder for patients B and C but left medical records indicating injections were given to both shoulders.

This was uncovered by another doctor who was an acquaintance of patient A. After hearing about the issue with the medical records from the doctor friend, patient A collaborated with patients B and C, who were also treated at the same hospital, to gather evidence and report it to the relevant authorities. They submitted evidence such as imaging from the time of treatment and medical fee receipts to the National Health Insurance Service and the local health center.

The National Health Insurance Service conducted an on-site investigation in November last year and confirmed the likelihood of excessive billing. The health center also conducted an on-site investigation and subsequently reported the hospital to the police. The Ministry of Health and Welfare conducted an on-site investigation last month. The authorities are investigating further, suspecting there may be more cases of excessive billing at this hospital.

The hospital denies the allegations, explaining that they believed it was permissible to charge additional fees for anesthesia injections. However, the authorities judged that this explanation indicated there was indeed inflation of medical fees.

Patient B emphasized, “I believe the public is suffering due to the selfish behavior of doctors amid recent increases in medical school admissions. Doctors who betray the public and only look out for their own interests deserve criticism. That is why I cooperated with other patients to uncover this corruption. I hope the immoral doctor receives severe punishment.”

Even if improper billing is ruled... only light punishment

On the morning of the 9th of last month, a medical official was waiting for the pedestrian signal at a crosswalk near a large hospital in downtown Seoul.

However, even if a ruling is made on improper billing, it takes a long time to reach punishment. The hospital’s appeals and administrative lawsuits complicate the process, causing delays in punishment, and even if punished, the suspension of the doctor’s license typically lasts only about a month.

According to a report titled "Key Contents and Issues of the 2nd Comprehensive National Health Insurance Plan" released by the National Assembly Research Service on the 15th, the health insurance finances will shift to a deficit of 307.2 billion won in 2026, and the deficit will increase to 1.5836 trillion won by 2028.