'Ajumma Broker' Goes Viral... The Amazing 'Byeongcance' of Fake Patients [Economic Crime 24 Hours]

Forgery of Medical Records to Illegally Receive 2.4 Billion Won in Insurance Payments
Hospital Director Arrested... Nurses and Physical Therapists Also Booked
Patient Repeatedly Hospitalized Falsely to Obtain Tens of Millions Won

A hospital in Gimpo, Gyeonggi Province. This place, where both Western and Korean traditional medicine consultations are available, was always crowded with patients. There was a constant flow of both outpatients and inpatients. This hospital, which was especially frequented by people suffering from aftereffects of traffic accidents, became the target of a police investigation in February of this year. The Criminal Mobile Unit of the Gyeonggi Nambu Police Agency, acting on requests from insurance companies, suddenly raided the hospital one day.

As the police investigation continued, the crimes of the hospital director, Kwon Mo (53), were gradually revealed. The charges confirmed by the police against Kwon were three in total: violation of the Medical Service Act, fraud, and violation of the Special Act on the Prevention of Insurance Fraud. Searches and seizures at the hospital followed, and Kwon was eventually arrested on June 21. What exactly happened?

According to the police, from January 2020 to May 2023, Kwon is accused of falsifying medical records and other documents to admit fake patients and fraudulently claim 2.4 billion KRW in insurance money under the pretext of manual therapy and other treatments. Throughout this audacious crime, Kwon had accomplices.

Kwon employed three professional hospital brokers as his hospital’s administrative manager and administrative section chief, then brought in fake patients and paid incentives if hospital bills exceeded 100 million KRW. These patients neither were actually ill nor needed hospitalization, but Kwon loosely examined them and recommended admission. They fabricated documents to appear as if they were hospitalized to fraudulently receive daily hospitalization allowances from insurance, but investigations revealed that they actually lived at home or even went to work.

Additionally, when patients who had suffered traffic accidents visited the hospital, Kwon recommended manual therapy. These patients also had no significant aftereffects but complied with Kwon’s suggestion. The hospital’s manual therapy was a high-cost treatment, charging 80,000 KRW for 30 minutes, 150,000 KRW for 1 hour, 230,000 KRW for 1 hour 30 minutes, and 300,000 KRW for 2 hours. Kwon provided only 2 to 3 actual manual therapy sessions but manipulated medical records to show more than 10 sessions.

Hospital staff were also directly or indirectly involved in the crimes. Nurses falsified nursing records, and manual therapists knowingly turned a blind eye to Kwon’s crimes. Notably, one of the manual therapists was found to be an unqualified general masseur.

Police investigations revealed that 194 people fraudulently admitted to the hospital and unjustly claimed insurance money, and 269 people pretended to have received more manual therapy than they actually did. The police believe these individuals came to the hospital after hearing about it from so-called ‘ajumma brokers’ (middle-aged women brokers) to claim insurance money.

The Criminal Mobile Unit of the Gyeonggi Nambu Police Agency, which investigated the case, not only arrested director Kwon but also booked four nurses, two manual therapists, three brokers posing as hospital staff, two insurance planners, four ‘ajumma brokers,’ 194 fake inpatients, and 269 manual therapy patients without detention.

Moreover, including those not yet investigated, it is estimated that many more people were involved in this insurance fraud. A police official stated, “Since the investigation is not yet complete, the number of those booked is expected to increase,” adding, “Investigations remain for about 100 people, including nurses and fake inpatients.”