Medical facilities that allegedly engaged in fraudulent practices, such as inducing patients to prepay high medical fees after confirming their health insurance status and offering cash or massage coupons as part of a 'payback' scheme, are now under investigation.
On August 28, the Ministry of Health and Welfare's administrative investigation team announced that it has referred 15 medical institutions suspected of illegal reimbursements to the police for further investigation.
This action marks the third referral following investigations conducted in July. The administrative team selected these 15 facilities based on cases reported to the 'Abnormal and Fake Treatment Reporting Center' by the end of July and the need to clarify specific legal violations among the institutions targeted in the second investigation. With this latest referral, the total number of medical facilities under police investigation has risen to 33 since the administrative team's establishment in June.
Among the 15 facilities referred for investigation, eight are nursing hospitals, four are oriental medicine clinics, two are clinics, and one is a general hospital. Geographically, four are located in Gyeonggi Province, three in Seoul, and three in Gwangju and Jeonnam.
The fraudulent practices identified at these medical institutions were bold and sophisticated. For instance, Hospital A allegedly induced a cancer patient to prepay approximately 10 million won for a package after confirming their health insurance enrollment during an admission consultation. They promised to provide 500,000 won in health insurance benefits each month, and when the patient declined, they reportedly refused to admit the patient's family member.
Hospital B was found to have encouraged patients to pay for expensive package hospitalization fees regardless of their health status, offering reimbursements in the form of coupons for cafes, nail salons, and massages, as well as taxi fare support.
Some facilities meticulously executed their schemes by creating 'discount management sheets' for each patient. Hospital C is accused of providing tailored discounts based on patients' insurance enrollment status and manipulating medical records and prescriptions to facilitate insurance claims.
Hospital D allegedly concealed the payback scheme by conducting cash transactions for admission and discharge fees, scheduling treatments like high-frequency and skin beauty injections in advance, and providing cash paybacks based on a month's treatment fees. Reports also indicated that they allowed hospitalized patients to leave freely.
The administrative investigation team plans to launch a third round of investigations in early September. Additionally, to fundamentally eradicate abnormal and fraudulent treatments, they will establish a cooperative framework with the Korean Medical Association and promote the 'Expert Evaluation System' to enhance self-regulatory efforts within the medical community.
Kwack Soon-hun, head of the administrative investigation team for abnormal and fraudulent treatments, stated, "The government views abnormal and fraudulent treatments as a chronic practice that harms legitimate medical institutions and patients, leading to financial leaks in health insurance and health insurance. We will respond strictly and decisively. We will thoroughly verify the legality of reported cases through administrative investigations and referrals to law enforcement."
Report abnormal and fraudulent treatments: Call 129 or email medi129@korea.kr (available to patients, guardians, and medical staff)
* This article has been translated by AI.
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