"False Claims for Medical Services Not Provided"... 17 Care Institutions Illegally Gained 320 Million Won

Ministry of Health and Welfare to Publish Institution Names, Addresses, and Representative Names for 6 Months

The list of 17 medical institutions that falsely claimed health insurance benefits by fabricating medical treatments that were not actually performed has been disclosed.

On the 23rd, the Ministry of Health and Welfare announced that the list of medical institutions that falsely claimed health insurance benefits will be published for six months until April 21 next year on the websites of the Ministry of Health and Welfare, the Health Insurance Review and Assessment Service, the National Health Insurance Corporation, and the health centers of the relevant local governments.

The health insurance false claim institutions disclosed this time include 8 clinics, 3 dental clinics, and 6 Korean medicine clinics. According to Article 72 of the Enforcement Decree of the National Health Insurance Act, the institution name and address, type, representative’s name, license number, violation details, and administrative sanctions will be disclosed.

The Ministry of Health and Welfare, after deliberation by the Health Insurance Disclosure Review Committee, annually discloses the list of medical institutions that falsely claimed benefits where the false claim amount is 15 million KRW or more, or the ratio of the false claim amount to the total benefit cost is 20% or more, in the first and second half of the year.

Accordingly, the total amount falsely claimed by the 17 disclosed institutions was 920.24 million KRW. The average false claim period per institution was 29.2 months, and the average false claim amount was 54.13 million KRW, with some institutions obtaining illicit gains as high as 327.57 million KRW.

In disclosed cases, Institution A falsely recorded drugs that were not actually administered in the medical records and claimed 28.94 million KRW for drug costs and other benefits. Institution B increased the number of simple radiographic imaging procedures beyond the actual number performed and claimed 26.22 million KRW in benefits, gaining illicit profits.

The Ministry of Health and Welfare has taken measures including recovering illicit gains, disclosing the list, filing criminal charges for fraud under the Criminal Act, and imposing business suspension orders of 64 days and 35 days respectively on these institutions.

Since the false claim disclosure system was implemented in February 2010, a total of 517 medical institutions have been disclosed to date. By type, there are 254 clinics, 162 Korean medicine clinics, 45 dental clinics, 18 pharmacies, 14 long-term care hospitals, 13 hospitals, and 11 Korean medicine hospitals.

Lee Jung-gyu, Director of the Health Insurance Policy Bureau at the Ministry of Health and Welfare, stated, "We will strive to contribute to the eradication and awareness of false claims and to prevent leakage of health insurance finances by disclosing the list of medical institutions that falsely claim health insurance benefits."