After cosmetic surgery for ‘Nail Long Patient’… “Pain treatment” was deceived into winning 7.2 billion won｜Dong-A Ilbo

141 people, including nursing hospital director, caught for ‘insurance fraud’
Recommend hospitalization for cancer patients and provide false medical treatment
Illegal receipt of 1.2 billion won in nursing care benefits, including hospitalization expenses
136 patients, 6 billion won in actual loss insurance money stolen

141 people, including the hospital director, were caught for admitting so-called ‘naive patients’ who had no major problems in their daily lives, providing them with skin care procedures such as whitening and wrinkle improvement, and collecting health insurance benefits and actual loss insurance money under the pretense of providing pain treatment. The money they stole over three years amounted to 7.2 billion won.

The Financial Supervisory Service, National Health Insurance Corporation, and Namyangju Northern Police Station are investigating the director of a nursing hospital, two doctors, and a nurse in Gapyeong-gun, Gyeonggi Province, who received 6 billion won in actual loss insurance and 1.2 billion won in health insurance benefits through fake medical records from May 2021 until recently. It was announced on the 18th that 1 person, 1 head of counseling, and 136 patients were caught.

● Making fake treatment plans and performing cosmetic procedures

This nursing hospital used a tactic of recommending that cancer patients in their 50s and 60s with previous hospitalization records be hospitalized again. He also suggested that if interest is shown, a medical record can be prepared as if pain treatment was performed in accordance with the coverage limit of the actual loss insurance product that the patient has already subscribed to, and in fact, cosmetic procedures can be performed.

If the patients accepted this plan, the nursing hospital created a fake treatment plan that would allow them to bill insurance money of 5 to 6 million won per month. It is said that hospital staff, including nurses and skin therapists, wrote down treatment plans like passwords and shared manuals to prevent detection.

The method used was to write ‘pain treatment’ that can claim health insurance benefits at the top of the false treatment plan, and write actual procedures such as ’00 Teacher Aroma’ at the bottom. After performing cosmetic procedures such as aroma oil management services, the doctors issued false medical records, including pain treatment, according to a fake treatment plan designed by the nursing hospital director or counseling director. It is said that the nursing hospital has become known by word of mouth among patients as “a hospital that makes it easy to file insurance claims and also provides skin care services.”

● Patients apply for actual cost insurance and hospitals apply for nursing care benefits.

An official from the Financial Supervisory Service explained, “The nursing hospital made up medical records to make it look like the patients mainly received ‘non-invasive pain-free signal therapy (Pain Scrambler).’” This therapy is a non-benefit therapy applied to relieve chronic pain and intractable pain, and patients must pay 100,000 to 200,000 won.

The patients submitted these records to the insurance company and received a total of 6 billion won in actual loss insurance. It was found that 136 patients received an average of 44 million won per person, and about 10 of the patients received more than 100 million won. The average length of hospitalization for patients was one year, and it is said that patients were hospitalized until they completed all 365 days of hospitalization covered by actual loss insurance products or until the coverage limit was exhausted.

During this period, the nursing hospital fraudulently received 1.2 billion won in nursing care benefits by directly requesting benefits such as hospitalization expenses and meal expenses from the National Health Insurance Corporation.

The Financial Supervisory Service said, “There are many cases in which not only the hospitals that led the insurance fraud, but also the patients who agreed with or participated in their suggestions were criminally punished. “Please be especially careful not to become involved in insurance fraud.” Under the Special Act on Prevention of Insurance Fraud, if you receive insurance money through insurance fraud, you may be punished by imprisonment for up to 10 years or by a fine of up to 50 million won.

Reporter Cho Yu-ra jyr0101@donga.com

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