National Health Insurance Service Busan-Ulsan-Gyeongnam Headquarters Provides Consulting Support from the Early Operation Stage of New Long-Term Care Institutions

Preliminary Inspection Support for Overall Operation of Long-term Care Institutions Including Institution Management and Claims

The National Health Insurance Service Busan, Ulsan, and Gyeongnam Regional Headquarters (Director Choi Deok-geun) is promoting the ‘Long-term Care Institution Pre-consulting’ project targeting long-term care institutions that have been operating for less than one year.

This project aims to support the stable early operation of institutions by visiting long-term care institutions directly, addressing the operators' questions one by one, and checking institution management, appropriate claims, and related matters.

The amount detected as fraudulent claims in long-term care institutions reached 60 billion KRW last year alone and has shown an increasing trend every year since the implementation of the long-term care insurance system. While some fraudulent claims are intentional and malicious, there are also cases where claims are recovered due to a lack of knowledge about the claim standards.

Accordingly, the Busan, Ulsan, and Gyeongnam Headquarters started consulting with 10 institutions in 2021 to prevent fraudulent claims caused by ‘lack of knowledge’ from the early stages of operation and to establish a sound benefit order, aiming for 50 institutions this year. Reflecting the high satisfaction and the helpful results of the consulting, the headquarters is expanding the project annually.

The Busan, Ulsan, and Gyeongnam Headquarters plans to continuously carry out various projects that help sound institution management and efforts for mutual development with long-term care institutions that will be a reliable support for the elderly’s stable later years.