Fake Gynecomastia Patients Recruited... Insurance Fraud Gang Embezzled 1.2 Billion Won Caught

False Medical Certificate Issuance for Insurance Claims
Pre-Education for Loss Adjuster Review
Hospital Director Also Administers Remaining Medication After Surgery

Hospital officials and brokers who organized a group to recruit fake patients and falsified medical certificates and records to claim insurance money worth approximately 1.2 billion won were arrested by the police.

The Seoul Metropolitan Police Agency's Metropolitan Investigation Unit Mobile Squad announced on the 28th that they had booked 174 people, including hospital officials and brokers, on charges of violating the Special Act on the Prevention of Insurance Fraud, and five of them were detained. The five detained suspects were sent to the prosecution. Additionally, a director and a doctor who habitually abused leftover narcotics through false surgeries or performed cosmetic procedures on patients for the purpose of drug administration were also booked on charges of violating the Narcotics Control Act.

[Image source=Yonhap News]

According to the police, from November 2022 to July of last year, they recruited patients with actual expense insurance for gynecomastia and hyperhidrosis, created false medical certificates without performing actual surgeries, and embezzled insurance money worth approximately 1.2 billion won over 200 cases.

The hospital medical staff operated systematically under the direction of the hospital director A, the mastermind, dividing roles into counseling team, management team, and nursing team. When brokers brought fake patients, they falsely created medical certificates and medical records as if surgeries had been performed for six hours on the same day to embezzle insurance money.

The brokers consisted of organized crime members, hospital officials, and insurance planners, and they recruited various occupational groups nationwide, including nurses, entertainment industry workers, and insurance planners. Among the fake patients were also family members of the brokers.

During the crime, it was additionally confirmed that hospital director A and doctor B administered leftover propofol from false surgeries or frequently performed cosmetic procedures on patients for the purpose of propofol administration. Police investigations revealed that they conducted medical consultations or surgeries while under the influence of propofol and fentanyl.

The hospital conducted preliminary training for fake patients to prepare for document reviews by loss adjusters, fearing that the crime would be exposed. Some organized crime members disguised as fake patients intentionally inflicted wounds on their chest area or submitted surgery photos of others.

A police official stated, "Insurance fraud is a serious social harm involving not only individual deviations but also hospitals and professional brokers," and added, "The police plan to proactively respond to insurance fraud crimes through intelligence gathering and crackdowns."