Financial Supervisory Service to prevent insurance fraud with Health Insurance Corporation-Maeil Economy

After recruiting patients through a broker, Hospital A prescribed an injection for obesity treatment that could not be charged to health insurance (non-payment items). After that, it was manipulated as an insurance claimable cold treatment, and the records were falsely written as if the patient had received outpatient treatment. In this way, Hospital A issued a false medical certificate and a false medical bill receipt for 252 patients, unfairly receiving 536 million won from the private insurance company, and intercepted 33 million won by falsely requesting the National Health Insurance Service for medical care benefits. .

On the 25th, the Financial Supervisory Service announced that it held the launching ceremony of the’Public and Private Insurance Joint Investigation Council’ with the National Health Insurance Corporation to prevent such systematic insurance fraud and unfair claims for health insurance. The two organizations conducted business cooperation based on the Memorandum of Understanding (MOU) signed in 2013, but they plan to further strengthen public and private insurance investigations through this council.

As in the case of hospital A, damage caused by insurance fraud occurs not only in private insurance but also in public insurance, so cooperation with related organizations is essential. First, the two organizations decided to hold a council regularly to jointly investigate large-scale insurance frauds linked to private health insurance. In particular, it plans to carry out a planning investigation on false claims that are not covered by real-life insurance coverage, thereby depriving insurance money and health care benefits at the same time. In addition, in relation to the investigation of insurance fraud, the company plans to strengthen its investigation capabilities by sharing the investigation techniques and educational information possessed by the two organizations.

An official from the Financial Supervisory Service said, “We expect to be able to eliminate the blind spot for public and private insurance fraud that has not been investigated so far, and raise awareness of insurance fraud.”

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