Fraudulent Claims in Elderly Care Facilities Total 51.2 Billion Won Over the Past 3 Years

Various Violations Including 38.8 Billion KRW Overcharges and Undercharges, 8.1 Billion KRW False Claims Occurred

Won-i Kim, Member of the National Assembly (Democratic Party, Mokpo-si, Jeollanam-do)

[Asia Economy Honam Reporting Headquarters Reporter Seo Young-seo] In the past three years, the detection of fraudulent claims in elderly care facilities has significantly increased, with the amount of fraud exceeding 50 billion won.

According to data submitted by the National Health Insurance Service to Kim Won-i, a member of the National Assembly from the Democratic Party of Korea (Mokpo City, Jeonnam), among 2,587 elderly care facilities investigated over the past three years due to suspected fraudulent claims, 2,257 institutions, accounting for 87%, were found to have committed fraud. The amount detected as fraudulent claims exceeded 51.2 billion won. Both the number of institutions caught and the amount of fraud detected have increased annually over the past three years.

The types of fraudulent claims include violations of fee adjustment rules amounting to approximately 38.8 billion won (75.8%), false claims of about 8.1 billion won (15.8%), violations of calculation standards around 3.3 billion won (6.4%), and other violations such as qualification criteria violations totaling about 1.1 billion won (2.1%).

As of August 2020, the National Health Insurance Service paid 1,416,438 cases and 2.4151 trillion won in benefits to elderly care facilities.

Assemblyman Kim Won-i stated, “Fraudulent claims occurring in elderly care facilities, where enormous financial resources are invested, can ultimately lead to a decline in the quality of services provided to the elderly using these facilities. Therefore, thorough supervision by the managing authorities is necessary.”