“I took the wrong medicine and became a criminal”… Gangnam ○○ Oriental Clinic is crowded

According to the financial authorities, oriental doctors and others who conspire in insurance fraud are being punished severely by the courts, and consumers need to be careful not to become complicit in insurance fraud. This is because, recently, consumers who participated with the thought of ‘I hope it is this much’ are being accused of being accomplices in insurance fraud and being punished by criminal penalties.

According to the Financial Supervisory Service on the 25th, according to the Financial Supervisory Service, the crime was mainly committed by the broker organization, “I will give you a free prescription for Gongjin,” and “You can get herbal medicines that are good for your body for free.” The profits were made in a way that the oriental clinic and the broker shared. It is reported that the broker organization was operated in a ‘multi-level’ method with dozens of people, including a representative and a general manager.

For example, at a medical clinic A in Gangnam, Seoul, a large number of doctors and brokers were discovered who gathered a lot of people who had indemnity insurance and committed fraud.

Their insurance fraud behavior was discovered by the KB Insurance Special Investigation Team (Special Investigation of Insurance Fraud), which thought that it was suspicious that insurance claims suddenly increased at a medical clinic A, where there were few insurance claims until 2019, and that patients from all over the country, including Busan and Gyeonggi Province, came to claim large-scale claims. Dulmi was caught by SIU).

Also, Oriental Clinic B prescribes an expensive saline drug that is not covered by insurance between June 2019 and November 2020, writes falsely as if it prescribed another treatment, and treats it as if it had been treated multiple times even though there was no actual treatment. The record book was falsely written 1869 times. Based on this, Oriental Clinic B issued false insurance claim documents (medical expense invoice, detailed statement, outpatient confirmation, etc.) After only one visit and receiving a healing agent for the purpose of health care, the patients were issued a false insurance claim document as if they had received outpatient treatment for bruises 3 or 4 times, claiming and defrauding the loss of insurance. In the end, 5 people including these broker organizations and medical personnel, and 653 patients and 658 patients were caught as insurance fraud (1.59 billion won), and the representative of the broker organization (2 years and August in prison) and the head of Korean Medicine Clinic B (4 years in prison) were sentenced to imprisonment. sentenced

There were also cases where ordinary housewives became criminals.

Hospital C and an acquaintance of a housewife, D, conspired to receive a fee for introducing a patient to the hospital, and introduced and mediated medical insurance subscribers to the hospital. In the end, D was sentenced to 1 year and 6 months in prison (probation).

The Financial Supervisory Service warned that the risk of insurance consumers being involved in insurance fraud is very high because broker organizations are disguising legitimate business activities and illegally recruiting large numbers of patients through social media (SNS), etc.

Kim Si-won, head of the Insurance Fraud Response Team at the Financial Supervisory Service, said, “If insurance consumers cooperate with brokers and claim medical insurance for medical loss with false documents, they may become accomplices in insurance fraud and face penalties such as criminal punishment.” “According to the special law, a person may be sentenced to up to 10 years in prison or a fine of up to 50 million won,” he said.

He further emphasized, “You must not receive financial benefits by cooperating with the lure or placement of patients by a corporate broker organization, and you must not respond to the wrong invitation to pay referral fees if you recruit other patients.”

Team leader Kim said, “After receiving a procedure that is not covered by the actual loss insurance, you must not claim the insurance money by fabricating it as if you received a covered treatment. It should not be inflated,” he urged. The Financial Supervisory Service plans to strengthen the investigation and detection of organized insurance fraud in cooperation with related organizations such as the Health Insurance Corporation and impose strict administrative sanctions.

Meanwhile, the Financial Supervisory Service and the insurance industry are operating a reward system related to insurance fraud detection. Suspected insurance fraud can be reported at the Insurance Fraud Prevention Center on the Internet website of the Financial Supervisory Service and at each insurance company.

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