The National Health Insurance Corporation will work with private insurance companies to conduct a joint investigation to prevent insurance fraud in which health insurance and private insurance are linked.
On the 25th, the Corporation announced that it held an inauguration ceremony for the’Public and Private Insurance Joint Investigation Council’ in which the Financial Supervisory Service, Life Insurance Association, and Non-life Insurance Association jointly participate in the conference room of the Dangsan Smart Work Center.
The Public-Private Insurance Joint Investigation Council plans to conduct intensive investigations on false or unjust claims for health insurance and on insurers of real loss insurance by private insurers to prevent financial leakage of national health insurance due to insurance fraud.
Insurance fraud involving medical institutions is a method in which patients claim insurance money from insurance companies using false medical records, and medical institutions claim medical care benefits from the Corporation, which has a great influence on the financial soundness of public insurance as well as private insurance.
A representative insurance fraud is the case of unfair claims by the secretary’s hospital.
Mr. A, who established a medical corporation in an illegal manner, unjustly requested 5 billion won in medical care benefit costs from the Corporation by falsely filling out medical records, etc., as if 191 patients were not actually hospitalized, as if they had been hospitalized and received normal treatment.
191 patients received unfair claims of 1.8 billion won in insurance from 31 insurance companies.
However, there was a problem in that private insurance fraud and the investigation of false or unfair claims for health insurance could not be linked due to the limitation of information sharing between public and private sectors.
Accordingly, the Corporation decided to hold a joint public-private insurance joint investigation council on a regular basis and conduct joint investigations such as large-scale insurance fraud cases linked to health insurance and private insurance.
It plans to carry out a plan and regular investigation on false and unfair claims for medical care benefits and indemnity insurance, and to strengthen investigation and detection capabilities by sharing investigation techniques and educational information possessed by each institution related to insurance fraud investigations.
The Corporation believes that the efficiency and detection effect of insurance fraud investigations will be high through public-private cooperation.
Kang Cheong-hee, executive director of salary, said, “Through close collaboration, the Corporation strengthened investigations into private insurance fraud, secretary hospitals, and false and unfair claims for health insurance, and realized financial soundness for health insurance, I will take the lead,” he said.
Director Kang said, “By conducting a joint investigation with the Financial Supervisory Service and the Insurance Association, we resolved the blind spots of public and private insurance fraud that had not been investigated so far, discovered a planning theme for joint insurance fraud investigation, analyzed the point of discussion, and requested a joint investigation to the investigating agency. It is expected that it will greatly contribute to preventing insurance fraud by raising awareness.”