Four Medical Institutions Caught Falsely Claiming Car Insurance Medical Fees

Four Korean Medicine Clinics Suspected of Illegal Claims Including False Auto Insurance Medical Fees to Face Criminal Charges

The Ministry of Land, Infrastructure and Transport announced on the 1st that it conducted a joint inspection with related agencies on four medical institutions and identified suspected illegal cases such as false claims for automobile insurance medical fees, deciding to take actions including criminal prosecution and imposition of fines in accordance with relevant laws.

The Ministry, along with local governments, public health centers, and the Health Insurance Review and Assessment Service (HIRA), conducted on-site inspections of four medical institutions from the 8th to the 15th of last month, confirming suspected illegal cases including two instances of batch pre-manufacturing of Korean herbal medicine prescriptions, one suspected case of hospital operation by an office manager, and four cases of unlicensed medical practice.

The act of providing batch herbal medicine to patients without individual prescriptions was also uncovered. For prescribing Korean herbal medicine, a Korean medicine doctor must appropriately administer it according to each patient's symptoms and diseases. However, the inspection revealed that herbal products were pre-ordered and provided in large quantities (over 900 packets) without individual prescriptions for each traffic accident patient’s symptoms and diseases.

Since the symptom location and severity, gender, age, and physical characteristics differ for each traffic accident patient, the type and amount of herbal medicine should be prescribed in a customized manner. However, the same herbal product, prepared in large quantities in advance with identical prescriptions, was provided to multiple patients in the same dosage.

In particular, although the cost of the herbal product was about 500 won and it could not be considered as herbal medicine under the automobile insurance medical fee standards, the medical institution claimed the drug cost based on the herbal medicine fee standard (7,360 won per packet, including decoction fee). The Ministry plans to file criminal charges against the medical institution under the Automobile Damage Compensation Guarantee Act (medical fee standards) and other relevant laws.

There was also a case where a nursing assistant, not a Korean medicine doctor, performed Korean physical therapy called Gyeonggeun Interferential Current Therapy (ICT) in the treatment room. Korean physical therapy must be performed directly by a Korean medicine doctor who should also claim the treatment fee. However, the inspection found that an unqualified person (nursing assistant) performed the therapy and the medical records were falsified to indicate that the Korean medicine doctor performed it. This may violate laws such as unlicensed medical practice (Medical Service Act) and falsification of automobile insurance medical records (Automobile Damage Compensation Guarantee Act), and the Ministry plans to file criminal charges against the medical institution accordingly.

Illegal acts such as failure to prepare records of outpatient leave and overnight stays for hospitalized patients were also revealed. Medical institutions must record and manage matters related to outpatient leave or overnight stays of patients hospitalized due to traffic accidents. However, the inspection found that the Korean medicine clinic did not prepare such records and failed to properly verify the return time and fact of return of patients who went out. This may violate the Automobile Damage Compensation Guarantee Act, and the related agency (district office) plans to impose fines on the Korean medicine clinic.

Jeon Hyung-pil, Director of the Mobility Automobile Bureau at the Ministry of Land, Infrastructure and Transport, stated, "Despite a decrease in traffic accident rates over the past five years due to illegal acts by some hospitals and clinics, payments for automobile insurance medical expenses for traffic accident patients have surged, causing leakage of automobile insurance funds and contributing to annual increases in automobile insurance premiums. We will strictly manage these hospitals and clinics to prevent moral hazard, ensuring that automobile insurance premiums paid by many citizens do not become a burden to the public."