Healthcare Institution Fraudulently Claiming Health Insurance with False Documents After Cosmetic Procedures

11 Cases of False Claims for Long-Term Care Benefits Disclosed

[Asia Economy Reporter Cho Hyun-ui] A nursing institution deceived the health insurance system by charging the full cost for cosmetic prosthetic and orthodontic treatments not covered by health insurance, while falsely claiming to have conducted examinations and tests that were never actually performed. Over 19 months, this nursing institution illicitly obtained 31,635,000 KRW in nursing care benefits through such methods. The institution was caught by health authorities, forced to return the illicit gains, and fined 197,806,000 KRW. It was also reported for fraud.

On the 20th, the Ministry of Health and Welfare disclosed the names of 11 nursing institutions that falsely claimed health insurance nursing care benefits. These include 8 Korean medicine clinics, 2 dental clinics, and 1 medical clinic, with a total false claim amounting to 415 million KRW.

The Ministry finalized the list of 10 institutions through the resolution of the 2019 second half Health Insurance Disclosure Deliberation Committee held on the 13th of last month, and added 1 institution confirmed through administrative litigation results related to disclosure measures.

The disclosure targets are institutions that received administrative sanctions for methods such as pretending to have treated patients without actually doing so, and whose false claim amount is 15 million KRW or more, or whose false claim amount accounts for 20% or more of the total nursing care benefit costs.

Lee Su-yeon, Director of the Insurance Evaluation Division at the Ministry of Health and Welfare, stated, "We will continue to strengthen on-site investigations of institutions suspected of false or improper claims and strictly enforce administrative sanctions on those caught. In particular, for institutions that falsely claim, we will implement not only administrative measures such as suspension of operations but also criminal prosecution and separate disclosure measures."