Billions in Bogus Claims: Long-Term Care Facilities Hit with 60 Billion Won in Unfair Expenses for the Third Time in 5 Years
Unfair Claims in Long-Term Care Facilities on the Rise
28.2 Billion Won Detected as of August This Year… “Institutions are Increasing, but Investigation Rate is Low”
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As we enter an era of 10 million elderly people, it has been revealed that the cost of long-term care benefits unfairly claimed by some elderly long-term care facilities has tripled in the past five years.
According to the results of an on-site investigation of long-term care facilities over the past five years received from the National Health Insurance Corporation by Kim Mi-ae, a People Power Party lawmaker and floor leader of the National Assembly Health and Welfare Committee, 1,342 long-term care facilities unfairly claimed 66.68 billion won in benefits last year.
The amount of unfair salary claims was 21.24 billion won (784 organizations) in 2019, but it has been increasing every year and has tripled last year.
This year, as of the 26th of last month, 737 organizations had unfairly claimed 28.27 billion won.
Long-term care facilities are institutions that provide long-term care benefits, where benefits refer to services such as nursing support or cash in lieu thereof for elderly people who are deemed to have difficulty performing daily life activities on their own for more than six months.
The amount of unfair claims per institution is also increasing every year.
In 2019, 27 million won was claimed from one place, but last year, the amount increased to 49 million won.
Although wage fraud claims are on the rise, the rate of on-site investigations remains below 5%.
Each local government conducts on-site investigations to create a transparent operating environment for long-term care facilities, including appropriate payment claims.
Rather than all long-term care facilities, we will selectively investigate facilities with a high probability of receiving fraudulent benefits through various methods, such as the big data-based Fraud Detection System (FDS).
For example, in 2020, 23,576 organizations claimed and received salaries, but only 799 organizations, or 3.8% of the total, were investigated on-site.
However, as the number of long-term care facilities increases every year due to the aging population, and the number of unfair claims for benefits also increases, there are opinions that the scope of the investigation should be expanded.
Rep. Kim Mi-ae said, “As our society ages, the number of long-term care facilities is increasing, but the rate of on-site investigations by management and supervisory agencies does not exceed 5%,” adding, “Since cases of unfair payments worth hundreds of billions of won occur every year, the Ministry of Health and Welfare and the National Health Insurance Service must thoroughly conduct on-site investigations and management and supervision regardless of the medical crisis.”
He added, “It is also important to grant judicial police powers to the public corporation’s officers and employees to conduct a quick investigation and recover unjust claims.”