Avoid Hospitals That Ask "Do You Have Silson Insurance?"

Financial Supervisory Service Consumer Alert Issued
Plastic Surgery, Skin Care, and Nutrient Injections Claimed as Manual Therapy... 4,000 People Involved in Insurance Fraud Over 3 Years
Criminal Punishment for Those Receiving Fake Medical Insurance Payments as Insurance Fraud Participants

At Hospital A, counseling staff proposed to customers that they could receive desired plastic surgeries and cosmetic procedures at a 80-90% discounted price and issue documents as if they had received manual therapy, enabling insurance claims. As a result, 25 people who underwent plastic surgeries (such as rhinoplasty, double eyelid surgery) and cosmetic procedures under the pretense of manual therapy were caught, fined between 500,000 and 3,500,000 KRW, and required to return the paid insurance benefits.

Insurance fraud involving false claims to insurance companies by disguising plastic surgery, skin beauty treatments, and nutritional injections as manual therapy is increasing. The financial authorities have urged special caution as people may be enticed by the word "free" and become involved in insurance fraud.

On the 8th, the Financial Supervisory Service (FSS) issued a consumer alert of the "caution" level regarding such insurance fraud. This is because insurance fraud involving disguising plastic surgery and skin beauty treatments as manual therapy has recently increased. According to the FSS, from 2019 to last year, a total of 3,096 patients were referred for investigation on suspicion of such insurance fraud. The number increased 110% from 679 in 2019 to 1,429 in 2022.

Although these individuals received cosmetic procedures not covered by indemnity medical insurance, they obtained false medical expense receipts and medical certificates as if they had received manual therapy for pain treatment and claimed insurance benefits. As this trend spread, the insurance industry strengthened investigations, leading to an increase in detected cases.

Until now, insurance companies have focused their fraud investigations on high-cost surgeries and diagnostic fees. It was difficult to allocate manpower and resources to relatively small amounts (average under 2 million KRW) such as manual therapy. However, recently, manual therapy insurance claims have surged, and it was discovered that some hospitals were conducting these frauds systematically. Professional organizations consisting of office managers, counseling managers, insurance planners, manual therapists, and beauty managers led the fraud, moving hospitals every 2-3 years. Consequently, insurance companies are strengthening their fraud investigation and response efforts.

The FSS strongly urged people not to participate in such insurance fraud. They explained that tempting proposals that do not make common sense should be doubted and firmly rejected. They emphasized that insurance fraud is always detected and encouraged active reporting of suspected fraud cases to the FSS or the insurance company’s insurance fraud reporting center. An FSS official stated, "Insurance fraud causes an annual financial leakage of 6.2 trillion KRW in private insurance and up to 1.2 trillion KRW in National Health Insurance. Such damage leads to increased insurance premiums affecting the general public and negatively impacts the health insurance finances."