Financial Supervisory Service, Police, and National Health Insurance Join Forces Against Insurance Fraud and Illegal Nursing Institutions Crimes

To eradicate crimes such as insurance fraud and illegally established care institutions, supervisory authorities, the police, and related agencies will form a cooperative system.

Lee Bok-hyun, Governor of the Financial Supervisory Service, is holding a press conference on the 4th at the Financial Supervisory Service in Yeouido, Seoul. Photo by Kang Jin-hyung aymsdream@

On the morning of the 11th, the Financial Supervisory Service (FSS) signed a Memorandum of Understanding (MOU) with the National Police Agency and the National Health Insurance Service (NHIS) at its headquarters in Yeouido, Seoul, to strengthen cooperation and eradicate crimes related to insurance fraud and illegally established care institutions. The signing ceremony was attended by Lee Bok-hyun, Governor of the FSS, Yoon Hee-geun, Commissioner of the National Police Agency, and Jeong Ki-seok, Chairman of the NHIS, along with officials from the three organizations.

According to the authorities, insurance fraud has recently been becoming more specialized and large-scale, involving not only individual deviations but also hospitals and professional brokers. For example, in a 10 billion won-scale insurance fraud case uncovered by the Busan Police Agency last November, one office manager was arrested and 469 people, including two doctors, were apprehended, demonstrating the trend toward specialization and large-scale operations.

On the other hand, the FSS and NHIS have limitations in joint responses due to restricted mutual information sharing, making it difficult to jointly initiate or detect major cases. Governor Lee stated, "Recently, insurance fraud methods have become more sophisticated and large-scale, with professional brokers conspiring with hospitals, and it is gradually expanding into a serious social problem. To eradicate evolving insurance fraud, smooth information sharing among related agencies and joint responses linking each agency’s expertise and infrastructure are necessary."

Accordingly, the three organizations will activate information sharing related to insurance fraud and illegally established care institutions through this agreement. The FSS will share information on hospitals and clinics related to insurance fraud identified through tips and reports with the NHIS, and the NHIS will share information on fraudulent claims for care benefits and illegal establishments with the FSS.

The National Police Agency will share information on insurance fraud and illegally established care institutions obtained during investigations or information collection with the FSS and NHIS. The three organizations plan to expand and reorganize the existing "Public-Private Joint Investigation Council," currently operated by the FSS and NHIS, to include the National Police Agency, and operate it regularly to discuss information exchange channels and methods.

Investigations and inquiries into insurance fraud will also be strengthened. The FSS and NHIS plan to conduct joint investigations on hospitals and clinics suspected of insurance fraud, selected through analysis of tips and reports, and will form a task force (TF) if necessary. The National Police Agency plans to strengthen support for prompt investigations by linking with special crackdowns on insurance crimes.

The three organizations will also support enhancing investigative and inquiry capabilities among agencies. Collaborating with the Insurance Association and others, they will expand training programs (Insurance Crime Prevention Academy) for related agency personnel such as police investigators and NHIS inspectors. Additionally, the three organizations plan to jointly conduct public awareness campaigns.

Commissioner Yoon stated, "Insurance fraud is an act of embezzling public funds that causes harm to all honest insurance subscribers and undermines the foundation of the insurance system, which is a social safety net. Going forward, we must share professional capabilities and information among agencies to increase synergy, cooperate mutually to respond comprehensively to illegal activities, and work together to prevent damage to the public."