"Consulted Patients Who Never Came?"... 26 Hospitals Revealed for False Health Insurance Claims

Ministry of Health and Welfare:
"Recovering Unjust Gains, Imposing Suspensions, and Filing Criminal Fraud Charges"

A total of 26 medical institutions have been caught for recording treatments as if patients had visited, even though no such visits occurred, and then claiming consultation fees and other charges as health insurance benefits.

On November 27, the Ministry of Health and Welfare announced that it will publicly disclose on its website, for six months, the names of medical institutions that have falsely claimed health insurance benefit payments.

The list includes one hospital, sixteen clinics, two dental clinics, one Korean medicine hospital, and six Korean medicine clinics. The disclosed information includes the institution’s name and address, type, representative’s name and license number, details of the violation, and administrative sanctions imposed.

These institutions were found to have either recorded in medical records that patients visited and received treatment when they actually did not, and then claimed consultation fees from the National Health Insurance, or claimed consultation fees again from health insurance after already receiving non-insured treatment fees directly from patients.

The total amount falsely claimed by these 26 institutions in this manner amounts to 2,313,800,000 won. Of these, seven institutions were found to have falsely claimed more than 100 million won each.

In accordance with the National Health Insurance Act, the Ministry will recover the unjust gains and impose work suspension measures on the institutions for a certain period. In addition, some institutions will be reported for criminal fraud under the Penal Code. The Ministry also plans to strengthen on-site investigations of institutions suspected of false claims and raise awareness through the public disclosure of names to prevent waste of health insurance funds.

Under the current National Health Insurance Act, institutions that have received administrative sanctions for falsely claiming health insurance benefits are subject to public disclosure of their names if the amount falsely claimed exceeds 15 million won, or if the proportion of false claims exceeds 20% of the total health insurance benefit amount. The Health Insurance Disclosure Review Committee decides whether to disclose the names after review.

Those subject to disclosure are notified in advance and given a 20-day period to present their case. The committee then re-examines their statements and materials before making a final decision on whether to disclose the names.

This content was produced with the assistance of AI translation services.