Nursing home insurance fraud group of 141 people caught… 7.2 billion won fraudulently claimed

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National Health Insurance Service branch in Seoul [Maeil Business Newspaper DB], ‘The National Health Insurance Service and the Financial Supervisory Service announced on the 18th that they uncovered a nursing hospital in Gapyeong, Gyeonggi Province, that committed insurance fraud totaling 7.2 billion won against the Health Insurance Corporation and insurers by keeping patients who were capable of daily activities hospitalized long-term while providing cosmetic treatments.’,
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, ‘The nursing hospital encouraged the readmission of existing cancer treatment patients from May 2021 to 2023. In reality, cosmetic procedures were provided, and insurance claims were made using false medical records. Patients received an average of 5 to 6 million won per month in insurance money, and the hospital separately maintained records of actual procedures and false medical records.’,
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, ‘The investigation revealed that 136 patients were hospitalized under the pretext of “nursing and skin care,” although they did not need treatment. Patients were persuaded by the hospital’s suggestion to “come for nursing care in good air and receive skin care,” leading them to receive cosmetic procedures. On average, each person received insurance payouts of 44 million won. Among them, it was found that over 10 individuals illegally received more than 100 million won each. The hospital also exceeded its authorized capacity of about 70 beds by increasing the number of long-term patients.’,
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, ‘They fraudulently received 1.2 billion won in nursing benefits from the Health Insurance Corporation and 6 billion won in indemnity insurance from insurers. The Namyangju Bukbu Police arrested them last month. A Financial Supervisory Service official advised, “There have been many cases where not only the hospitals leading the insurance fraud but also the patients involved in their proposals have been criminally prosecuted, so please be extra cautious not to become involved in insurance fraud.”‘,
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