"Proxy Hospital Fraudulently Claimed 21.1 Billion Won"... First-Ever 1.6 Billion Won Reward to Be Paid

NHIS to Pay a Total of 1.72 Billion Won
to Whistleblowers Who Reported Ten Healthcare Institutions

A record-high reward of 1.6 billion won will be paid to a whistleblower who reported a 'proxy hospital' that fraudulently claimed 21.1 billion won in health insurance benefits.

The National Health Insurance Service (NHIS) announced on May 8 that it held the '2025 First Health Insurance Reporting Reward Review Committee' and decided to pay a total of 1.72 billion won in rewards to whistleblowers who reported 10 healthcare institutions for submitting false or fraudulent claims for medical benefits.

According to the NHIS, these reports led to the detection of 23.25 billion won in false or fraudulent claims from 10 hospitals and clinics.

This time, a single whistleblower will receive the highest reward ever paid by the NHIS, amounting to 1.6 billion won. This whistleblower reported a so-called 'proxy hospital' illegally established and operated by a non-medical professional, identified as Mr. A, who borrowed a medical license to open the institution.

According to the NHIS, Mr. A, who was originally a sole proprietor, set up a proxy hospital under the name of his relative, Dr. B, and used the profits for personal expenses such as car installment payments and credit card bills. After a conflict arose with Dr. B over hospital management, Mr. A opened another proxy hospital with his partner, Ms. C, diverting profits by agreeing to pay annual salaries of 180 million won each to himself and Ms. C. The total amount fraudulently obtained through the operation of these proxy hospitals reached 21.1 billion won.

Other cases uncovered include a hospital consulting firm CEO who borrowed a dentist's license to open a dental clinic and embezzled 420 million won, and a dental clinic that falsely claimed 440 million won from the NHIS for non-covered treatments or treatments that were never provided. The respective whistleblowers will receive rewards of 30 million won and 50 million won.

Since July 2005, the NHIS has operated a 'Health Insurance Reporting Reward System' to prevent financial leakage from the health insurance fund. Related parties of healthcare institutions can receive up to 2 billion won, while general whistleblowers such as patients can receive up to 5 million won. Reports can be submitted through the NHIS website, mobile app, in person, or by mail, and the identity of the whistleblower is strictly protected under the Public Interest Whistleblower Protection Act.

Kim Namhun, Executive Director of Benefits at the NHIS, stated, "To eradicate increasingly diverse forms of false and fraudulent claims and the problem of proxy hospitals, the continued interest and prompt reporting by conscientious professionals and just citizens are more important than ever," urging active interest and participation in public interest reporting.