"Splitting Medical Appointment Days"... Doctors and Patients Collaborate to Claim 700 Million Won in Insurance Payments

Suspected Violation of the Special Act on Prevention of Insurance Fraud

A gang that recommended expensive treatments and falsified medical records to embezzle hundreds of millions of won in indemnity insurance payments was caught by the police.

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Photo by Seoul Police Agency

The Seoul Metropolitan Police Agency's Criminal Mobile Unit announced on the 28th that they plan to send 322 people, including orthopedic hospital director Mr. A and 321 patients from the hospital located in Seoul, to prosecution without detention on charges of violating the Special Act on the Prevention of Insurance Fraud.

Mr. A is suspected of recommending patients to use high-frequency treatment devices that incur high treatment costs from February last year to June this year, and issuing false documents as if they had received manual therapy or extracorporeal shock wave therapy. It was revealed that Mr. A committed these crimes by exploiting the loophole that the process of submitting documents to insurance companies when claiming indemnity insurance is simplified.

In particular, Mr. A used the so-called 'splitting treatment dates' method, issuing false receipts and detailed medical expense statements to make it appear as if patients who visited once had visited multiple times, and meticulously managed these by creating separate Excel files called 'splitting treatment dates' files to conceal them. The indemnity insurance money obtained by Mr. A and the patients from 21 domestic insurance companies amounted to about 700 million won.

He also promoted the hospital by appearing on popular portal sites and general programming broadcasts, emphasizing top-of-the-line equipment, private facilities, and his experience as a personal doctor to a famous chairman, and introduced patients through some insurance planners.

Additionally, the police are investigating the hospital deputy director Mr. B, who repeatedly performed unlicensed medical procedures (skin beauty treatments) at the hospital, along with 43 patients suspected of indemnity insurance fraud.

The police stated, "If the hospital agrees to proposals that minimize patient burdens, it could lead to increased distrust in the system due to insurance premium hikes, resulting in economic losses for society as a whole, and could make them accomplices in insurance fraud. The police will continue to monitor and collect intelligence on excessive compensation systems in non-essential medical fields and strengthen crackdowns."