Life and Non-Life Insurance Associations Join Forces to Eradicate Insurance Fraud in Long-Term Care Hospitals: "Operation of Focused Reporting Period"

Business Agreement Signed to Eradicate Insurance Fraud in Long-Term Care Hospitals
Advisory Letters and Promotional Posters to Encourage Self-Regulation and Reporting

The Life and Non-Life Insurance Associations have signed a business agreement with the Korea Association of Long-Term Care Hospitals to operate a focused reporting period for illegal activities aimed at eradicating insurance fraud in long-term care hospitals. They will distribute promotional posters urging self-purification efforts by long-term care hospitals and send advisory letters to these hospitals to encourage the eradication of insurance fraud and self-regulation efforts.

On the 22nd, the Life and Non-Life Insurance Associations and the Korea Association of Long-Term Care Hospitals announced that they signed a business agreement at the Post Tower Reception Center in Myeongdong, Jung-gu, Seoul, to eradicate illegal insurance fraud in long-term care hospitals and strengthen collaboration.

Recently, insurance fraud has evolved beyond individual deviations to involve hospital officials and brokers, becoming more specialized and large-scale. In the process of competitively attracting patients, some long-term care hospitals have increasingly engaged in cases of insurance money embezzlement, such as issuing excessive receipts followed by paybacks of medical fees, falsifying medical records, and false admissions.

Each association has decided to actively respond to illegal activities such as issuing excessive medical fee receipts followed by paybacks of the difference from actual medical fees, falsifying medical records, and recruiting patients through false admissions at some long-term care hospitals.

Each association will produce promotional posters urging self-purification efforts against illegal activities such as medical fee paybacks, falsification of medical records, and false admissions, and distribute them to long-term care hospitals nationwide. The Korea Association of Long-Term Care Hospitals will send advisory letters to its member hospitals to encourage the eradication of insurance fraud and self-regulation efforts.

They will promote the activation of reporting through the operation of a focused reporting period related to insurance fraud in long-term care hospitals. Detailed information about the focused reporting period will be finalized after discussions between the associations. The Korea Association of Long-Term Care Hospitals will review the reports and share facts of illegal activities with related organizations such as the Ministry of Health and Welfare and the National Health Insurance Service, and if necessary, proceed with disciplinary procedures according to its articles of association.

The Life and Non-Life Insurance Associations will form a legal support team and, after review by criminal law specialists, will conduct joint industry investigations on received reports. They plan to respond strongly, including requesting police investigations, for cases where criminal suspicion is confirmed.

The associations will share types of insurance fraud and, if necessary, operate seminars and educational programs to strengthen the capabilities of related personnel. They also agreed to cooperate mutually for amendments to relevant laws such as the Medical Service Act and the Special Act on the Prevention of Insurance Fraud, if necessary.

The Life and Non-Life Insurance Associations stated, "Through cooperation between the insurance industry and the medical community, we will induce self-purification efforts by some illegal long-term care hospitals and establish an organic response system against insurance fraud crimes in long-term care hospitals that infringe on people's livelihoods," adding, "The prevention of insurance fraud in long-term care hospitals and the investigation process of criminal suspicion will be expedited."