Conspiracy Between Designer and Hospital to Falsify Medical Records
Unlawful Acquisition of 260 Million Won in Insurance Money
Lina Life Insurance discovered a dental insurance fraud scheme involving an insurance agent, a hospital, and patients colluding together and reported it to the police for investigation. This is the first insurance fraud case involving an insurance agent being arrested for dental insurance.
According to Lina Life on the 7th, an insurance agent A, affiliated with an insurance agency (GA), conspired with B, the counseling manager of a dental hospital in Daejeon, to manipulate patients' dental records and claim insurance money.
The Anti-Corruption Economic Crime Investigation Unit of the Daejeon Police Agency received the case through the National City and Provincial Police Insurance Crime Investigation Council and uncovered the criminal activities of those involved. Under the Special Act on Insurance Fraud Prevention and other laws, one GA insurance agent was arrested, while one dental hospital counseling manager, three GA insurance agents, and 36 patients were booked without detention.
This is the first insurance fraud case involving an insurance agent being arrested for dental insurance, with not only dental hospital staff but also insurance agents all implicated. It is also the first case recognizing not only the insurance money but also recruitment commissions as criminal proceeds.
The arrested insurance agent A had family members and acquaintances falsely fill out information that should have been disclosed on the application forms and then enrolled them in insurance. Afterwards, the patients received treatment at the dental hospital where the counseling manager worked, and counseling manager B manipulated medical records to make it appear as if injuries occurred after insurance enrollment. Through this, the policyholders fraudulently obtained a total of 260 million KRW from six insurance companies. Insurance agent A and counseling manager B are suspected of receiving a portion of the insurance money paid to patients as illicit gains.
The Lina Life Insurance Fraud Investigation (SIU) team has been intensively investigating an organized dental insurance fraud case involving GA insurance agents and dental hospital staff since 2022. They have confirmed multiple illegal activities, reported them to investigative authorities, and actively respond to sophisticated insurance fraud through meticulous analysis of key dental insurance fraud information.
A Lina Life Insurance official stated, "Strong sanctions and recurrence prevention measures against illegal activities are necessary to prevent insurance agents, who should protect consumers, from being involved in insurance fraud." They added, "Lina Life will enhance investigative expertise and strive for thorough detection of insurance fraud to ensure that honest customers do not suffer damages."
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