Increase in Insurance Fraud Using New Medical Technologies... Financial Supervisory Service to "Strengthen Planned Investigations"

Sharp Increase in Knee Injection Insurance Claims
Mass Claims from Korean Medicine Hospitals

The Financial Supervisory Service (FSS) announced on the 24th that it will strengthen planned investigations into new medical technology treatment items with rapidly increasing claims and payments for indemnity insurance, as well as the top non-reimbursable treatment items with high indemnity insurance payments.

Since the Ministry of Health and Welfare's notification in July last year approving knee injection as a new medical technology, the number of insurance claims surged from 38 cases in the same month to 1,800 cases in January this year. During the same period, the amount of insurance payments skyrocketed from 120 million KRW to 6.34 billion KRW.

The hospitals filing claims have also been expanding from orthopedic and rehabilitation departments to ophthalmology and Korean medicine hospitals. Among these, three Korean medicine hospitals accounted for 18% of the total claimed amount. Insurance fraud linked to broker organizations that refer patients to hospitals continues to spread.

The FSS plans to regularly investigate trends in fraud-prone areas through meetings with the insurance industry and analysis of insurance payment status. If necessary, it will jointly visit medical sites with the insurance industry to assess the actual situation of new medical technology treatments.

An FSS official stated, "Regarding organized insurance fraud involving hospitals and brokers, we will promptly initiate investigations and refer cases for prosecution once suspicion is detected," adding, "We plan to actively respond through cooperation with investigative agencies and the National Health Insurance Service."