Methods such as exaggerated symptoms and treatment frequency
Suspected of receiving insurance money of 1.1 billion and distributing it,
View of Daegu Metropolitan Police Agency. Source: Hankook Ilbo,
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, ‘Doctors, nurses, insurance planners, and fake patients have been caught in bulk for claiming large amounts of insurance money by recruiting fake patients and manipulating surgery records for billing.’,
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, ‘On the 17th, Daegu Southern Police Station arrested a 50s doctor, Mr. A, a 60s nurse, Ms. B, a 50s insurance planner, Mr. C, and Mr. D for violating the Special Law on Prevention of Insurance Fraud for obtaining insurance money of 1.1 billion won through false medical/surgical records. 95 fake patients who shared a portion of the insurance money were also booked without detention on the same charges.’,
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, ‘Mr. A and others fraudulently received about 1.1 billion won in insurance money over 2 years and 10 months from January 2019 to November 2021 using these methods.’,
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, ‘They targeted relatively easy claims such as burns or women’s diseases by taking advantage of the fact that they could easily receive actual medical expense benefits with diagnoses issued by hospitals. Even for minor burns, Mr. A created diagnostics as severe as third-degree burns (burns deep into the skin) for which insurance claims were possible. He falsified medical records to make it look like surgeries were performed for women’s diseases even though they were not actually conducted. On instructions from Mr. A, Ms. B wrote the necessary documents for insurance claims and provided them to insurance planners or fake patients, or introduced fake patients to hospitals. ‘,
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, ‘Insurance planners C and D recruited customers without a history of receiving actual medical expense benefits from family or friends, and once they received fake diagnoses from Mr. A’s hospital to claim insurance money, they pocketed referral fees ranging from 1 million to 10 million won per person. Fake patients received insurance money ranging from 1.6 million to 45 million won per person.’,
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, ‘The hospital in question later closed down.’,
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