Medical Institutions Publicly Exposed for False Claims of Health Insurance Benefits, Gaining Hundreds of Millions Through Double Billing of Fake Patients

Available for 6 Months on the Ministry of Health and Welfare and Local Government Websites

[Asia Economy Reporter Lee Gwan-ju] Institution A falsely claimed 222.34 million KRW in medical fees by recording patients who never actually visited for treatment as if they had received care. In addition, they deceptively prescribed and administered herbal medicine that was never actually given, claiming an additional 16.13 million KRW. Over three years, Institution A obtained undue benefits by submitting false claims for medical fees. When uncovered during an official investigation, the institution was subjected to recovery of the illicit gains, a 154-day suspension of operations, public disclosure of its name, and was reported for fraud.

Institution B performed non-covered skin care procedures and charged patients the full amount out-of-pocket, yet also double-billed consultation fees and other costs as covered medical expenses. The total undue gains over 30 months amounted to 85.34 million KRW. After being caught, this institution faced recovery of the illicit gains, a 162-day suspension of operations, public disclosure, and was reported for fraud.

The Ministry of Health and Welfare announced on the 6th that it will publicly disclose the list of medical institutions that falsely claimed health insurance medical fees on its website and other platforms for six months. The disclosure includes the institution’s name, address, type, representative’s name, gender, license number, violations, and administrative sanctions.

The list will be available not only on the Ministry of Health and Welfare’s website but also on the Health Insurance Review and Assessment Service, National Health Insurance Service, relevant local governments, and public health center websites until August 5. Institutions subject to disclosure are those that have been administratively sanctioned for false claims amounting to 15 million KRW or more, or where the false claim ratio exceeds 20% of the total amount. The disclosure list was determined through review by the Health Insurance Disclosure Deliberation Committee.

Among the 20 institutions disclosed this time, clinics were the most common with 9, followed by Korean medicine clinics with 6, dental clinics with 4, and one Korean medicine hospital. Six institutions falsely claimed over 70 million KRW, five institutions each fell into the 50 to 70 million KRW and under 30 million KRW ranges, and four institutions were in the 30 to 50 million KRW range. The highest false claim amount was 238.47 million KRW by the aforementioned Institution A. The average false claim period per institution was 32.2 months, with an average amount of 62.28 million KRW.

Jung Jae-wook, Director of the Insurance Evaluation Division at the Ministry of Health and Welfare, emphasized, "We will continue on-site investigations of institutions suspected of false or improper claims and strictly enforce the public disclosure system alongside administrative sanctions such as suspension of operations for institutions found to have submitted false claims."