Fifty-eight medical institutions and pharmacies have been publicly identified for illegally claiming health insurance benefits by fabricating patient visits or inflating the number of X-ray procedures. The government aims to prevent financial losses in the health insurance system through rigorous local investigations and transparent disclosure of fraudulent institutions.
The Ministry of Health and Welfare announced on October 1 that it will publish the names of these 58 institutions that falsely claimed health insurance benefits over the next six months on its website. The institutions listed have received administrative penalties, including business suspensions or fines, for fraudulent claims made between September 2025 and February 2026.
Among the 58 institutions identified, 36 are clinics, followed by 10 dental clinics, 8 traditional medicine clinics, 2 hospitals, and 2 pharmacies. The total amount fraudulently claimed by these institutions is approximately 4.67 billion won, with an average false claim amount of 80.51 million won per institution and an average duration of fraudulent claims lasting 31 months.
In terms of the amount claimed, 22 institutions had claims of less than 15 million won, but 11 institutions exceeded 100 million won in fraudulent claims. The institution with the highest fraudulent claim, referred to as Institution A, falsely billed for consultation fees and traditional treatments despite no actual patient visits, accumulating an unjust gain of 927.37 million won over 17 months.
The Ministry has initiated recovery of the unjust gains from Institution A, imposed a fine of approximately 463.6 million won, and filed a criminal complaint for fraud. Institution B was also caught inflating the number of radiological examinations billed, resulting in 45.38 million won in fraudulent claims over 36 months.
The publication of these names occurs twice a year, in the first and second halves. Institutions subject to publication are those that have received administrative penalties for false claims exceeding 15 million won or where the false claim amount constitutes more than 20% of the total health insurance benefits claimed.
The Ministry selected the institutions through a review by the Health Insurance Disclosure Review Committee, which includes consumer groups, journalists, legal experts, and medical professionals. Institutions were notified in advance and given a 20-day opportunity to respond before final decisions were made.
The published information includes the names and addresses of the medical institutions, their types, the names and license numbers of their representatives, specific violations, and details of administrative penalties. This information will be publicly available from October 1 to March 31 of the following year on the websites of the Ministry, the Health Insurance Review and Assessment Service, the National Health Insurance Corporation, and local health authorities.
Yoo Joo-hun, Director of the Health Insurance Policy Bureau, stated, "We will continue to strengthen local investigations into suspected fraudulent institutions and rigorously implement the publication of names for those that commit fraud to raise awareness and prevent waste of health insurance funds."
Since the system was first implemented in February 2010, a total of 613 medical institutions have been publicly identified for fraudulent claims.
* This article has been translated by AI.
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