The National Health Insurance Service (NHIS) has decided to award a total of 469 million won to 18 courageous citizens who reported illegal and fraudulent claims related to health insurance, including so-called 'illegal medical centers' and 'fake patients.' The reported fraud amounts to over 6.2 billion won.
On September 10, the NHIS held its second reward committee meeting for 2026, where it reviewed and approved the distribution of rewards for reports involving 12 healthcare institutions that falsely claimed medical expenses, two illegally established institutions, and four cases of health insurance card misuse.
The committee has decided to grant a total of 469 million won to the 18 whistleblowers, with the confirmed amount of fraudulent claims reaching 6.22 billion won.
To prevent financial leakage in the health insurance system, the NHIS has operated a 'health insurance reporting reward system' since 2005. The largest reward of 176 million won was given to a whistleblower who reported an illegal medical center operated by a non-medical individual in collusion with a doctor.
According to the report, the non-medical individual, referred to as A, conspired with the doctor, B, to operate the illegal medical center, sharing profits by paying B 30% of the examination fees received from the NHIS.
Other fraudulent claims also raised eyebrows. Hospital B falsely reported nurses who did not work in the ward as 'dedicated ward nursing staff.' Despite the actual nursing staff being rated at levels 4 to 5, they inflated their rating to level 3, unlawfully claiming 395 million won in medical expenses. The whistleblower in this case received a reward of 45 million won.
Cases of health insurance card misuse were also uncovered. Individual A, who lost eligibility due to unpaid premiums, secretly used the health insurance card of his brother, B, to receive medical treatment. A unlawfully claimed 45 million won in medical expenses, and the whistleblower received a reward of 5 million won.
To combat increasingly sophisticated fraudulent claims, the NHIS unified the reward criteria for whistleblowers starting December 23, 2025, raising the maximum reward from 2 billion won to 3 billion won.
Kim Nam-hoon, the Executive Director of Benefits, stated, "To eradicate the growing issues of fraudulent claims and illegal medical centers, the continuous attention and prompt reporting from conscientious workers and just citizens are crucial. We urge active interest and participation in public interest reporting."
Reports of fraudulent healthcare institutions can be submitted through the NHIS website, mobile app, or by visiting NHIS branches and mailing in reports. The identity of whistleblowers is thoroughly protected under the Public Interest Whistleblower Protection Act.
* This article has been translated by AI.
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