NHIS "Considering a Full Survey"
Easier Recovery Than 'Samu-jang Hospitals'
The health insurance authorities investigated whether some medical institutions, including hospitals and clinics, falsely claimed COVID-19 treatment fees, and it was confirmed that all sampled institutions were caught. According to the 'COVID-19 Treatment Fee Fraud Sample Survey Data' received on the 14th by Jeong Chunsuk, a member of the National Assembly's Health and Welfare Committee from the Democratic Party of Korea, from the National Health Insurance Service, all 12 sampled medical institutions surveyed were found to have fraudulently claimed COVID-19 treatment fees and received medical benefits.
During the COVID-19 pandemic, there were repeated criticisms of indiscriminate diagnostic testing and fraudulent claims for medical benefits through non-face-to-face treatment by medical institutions. Accordingly, the National Health Insurance Service conducted a selective survey of 12 medical institutions nationwide that participated in COVID-19 treatment from October 17 last year to March 28 this year, confirming these facts.
Regarding the types of fraudulent claims, if a rapid antigen test for COVID-19 was performed on a person without respiratory symptoms such as fever, the test fee could not be claimed from the National Health Insurance Service, but it was falsely claimed as a benefit. During the COVID-19 vaccination process, consultation fees included in the vaccination cost were claimed redundantly, or consultation and treatment fees for diseases not treated on the vaccination day were falsely claimed. While conducting non-face-to-face COVID-19 treatment, some institutions claimed medical benefits under the name of patient telephone consultation management fees without actually providing telephone consultations.
The total amount of fraudulent claims reached 953 million KRW, with the largest amount being 535 million KRW in the non-face-to-face treatment category. A National Health Insurance Service official stated, "All fraudulent claims have been recovered." Considering that 100% of the sampled medical institutions fraudulently claimed COVID-19 treatment fees, the actual scale of illicit gains could be astronomical. According to the National Health Insurance Service, as of 2021, there are a total of 98,479 medical institutions nationwide, with clinics numbering 33,912, the largest group.
Since widespread false and fraudulent claims for COVID-19 treatment fees were revealed in this sample survey, the National Health Insurance Service is considering expanding the investigation nationwide. Even if most medical institutions are caught, they are likely to continue operations, so it is easier to recover funds compared to 'office-owner hospitals' that shut down immediately when caught.
Medical institutions that falsely or fraudulently claim will have their illicit gains recovered and face administrative sanctions such as suspension of operations for up to one year or fines. If necessary, their licenses under the Medical Service Act and Pharmaceutical Affairs Act may be suspended, criminal charges (fraud) filed, or their names publicly disclosed.
A National Health Insurance Service official said, "Since this sample survey suggests that the scale of fraudulent profits from COVID-19 treatment fees is large, a full-scale investigation is highly likely," adding, "The specific timing and methods of the investigation are still under review."
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