"Hospital Closes Doors and Performs Lifting Procedures Instead of Doctors"...Massive Detection of Fraudulent Claims for Long-Term Care Benefits

Operation of Medical Law Violation Reporting Period
False Work Records Using Medical Staff Licenses
Detection of Inflated Patient Numbers, etc.

It has been revealed that serious public financial leakage has occurred due to violations of the Medical Service Act by some hospitals, such as fraudulent receipt of medical benefits or excessive billing of medical fees.

The Anti-Corruption and Civil Rights Commission (ACRC) operated a focused reporting period for public interest violations of the Medical Service Act from the 22nd of last month to the 21st of this month, and announced major cases detected during this period on the 12th.

During the focused reporting period, cases of unlicensed medical practice and fraudulent receipt of medical benefits by falsely submitting the number of medical personnel or working hours were detected. Certain hospitals were also caught for opening office manager hospitals or inflating the number of patients.

Among these, Internal Medicine Clinic A located in Seoul, which was caught for fraudulent receipt of medical benefits, recruited patients through brokers, and when the doctor’s consultation hours ended in the evening, non-medical personnel performed lifting procedures at the procedure site. The doctor deceived by claiming to have performed 'scalp seborrhea' treatment and then claimed medical benefit costs.

In addition, 104 related persons, including doctors who committed illegal acts systematically, brokers, two unlicensed practitioners, and 100 fake patients, were prosecuted by the prosecution.

Hospital B located in Gyeonggi Province paid five nurses between 300,000 and 500,000 KRW per month as license rental fees and falsely claimed that they worked in a psychiatric closed ward. Subsequently, medical benefit costs amounting to approximately 1.6 billion KRW were embezzled and detected. The nurses who lent their licenses, the doctor who embezzled medical benefits, and the administrative director were prosecuted on charges including violation of the Medical Service Act.

C Nursing Hospital located in Jeollabuk-do fraudulently received costs by renting a doctor’s license and falsely claiming to have employed more doctors than those actually working. Furthermore, during the investigation, it was additionally revealed that the hospital was a 'office manager hospital' with problems from its establishment, and the amount of medical benefits embezzled due to this was confirmed to reach 25.8 billion KRW.

There was also a case of fraudulent receipt by inflating the number of patients. D Korean Medicine Clinic located in Incheon falsely registered medical records claiming to have treated 2,472 patients over three months, more than ten times the actual number of patients (163). The clinic was caught after claiming several hundred million KRW in medical benefits based on false records.

An ACRC official said, "Medical benefits, which should be used for the health of the people, are seriously leaking," and added, "We hope many reports on illegal acts and fraudulent receipt in the medical field will be submitted during the focused reporting period operating until the 21st."