Earned 700 million won through false medical records that met the ‘daily insurance payment limit’… Approximately 300 people arrested, including police and hospital directors
The deputy director is accused of illegal cosmetic procedures… ‘Medical shopping’ is encouraged and managed separately… Handed over manual to new hires
Mr. A’s hospital blog promotional material
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(Seoul = Yonhap News) Reporter Jang Bo-in = About 300 people, including the director of an orthopedic hospital and patients, who obtained hundreds of millions of won in actual loss insurance money by using false medical records, were caught by the police.
The Seoul Metropolitan Police Agency’s criminal task force announced on the 28th that it had arrested the hospital director, a man in his 40s, and 321 patients on charges of violating the Special Act on Prevention of Insurance Fraud. Mr. A was also charged with violating the medical law.
According to the police, they are suspected of stealing about 700 million won in actual loss insurance money by submitting false documents to 21 domestic insurance companies between February last year and June this year.
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Mr. A was found to have induced patients to receive expensive radiofrequency treatment, claiming that this was the treatment used by famous athletes, and created false medical records to claim that he had performed manual therapy and extracorporeal shock wave treatment in order to claim insurance.
By taking advantage of a loophole in the simplification of documents submitted to insurance companies during the actual loss insurance claim process, they used the ‘splitting treatment days’ method of issuing false receipts and detailed statements of medical expenses so that claims could be made by dividing the treatment days according to the daily insurance payment limit.
The police said that Mr. A conspired to engage in so-called ‘medical shopping‘ by confirming whether Mr. A had subscribed to actual medical loss insurance under the pretext of medical consultation, and then explaining to patients that he would ‘minimize the patient’s burden and ensure that there are no problems in the insurance claim process.’ I figured it out.
Mr. A’s hospital created and managed a list of patients who split treatment days in a separate Excel file to prevent illegal medical practices from being discovered.
Mr. A’s hospital treatment schedule is divided into patient management lists.
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In addition, it was found that slang known only to hospital staff was written in the medical record to instruct prescriptions, and that a manual-type manager handover form was created and used so that even new employees could easily perform the task of splitting treatment days.
The hospital has been promoting Mr. A through broadcast appearances and portal site blogs, and has gained the trust of patients by posting promotional posts introducing Mr. A as having served as the personal doctor of the chairman of a famous company and emphasizing that he uses the highest-end medical equipment. .
The police plan to transfer Mr. A and the patients who participated in the crime to the prosecution without detention within this month.
In addition, the police have also booked and are investigating Deputy Director B, who performed unlicensed medical practices, including skin care procedures, at this hospital, and 43 patients suspected of actual cost insurance fraud. It was confirmed that Mr. A’s wife, Mr. B, is not a doctor.
A police official cautioned patients about their participation in insurance fraud, saying, “It goes beyond an act for personal benefit, and may not only deepen distrust in the system due to increased insurance premiums and lead to economic losses for the entire society, but may also make them accomplices in insurance fraud.” requested.
He continued, “Insurance fraud is causing serious social harm, such as widening blind spots in medical coverage for vulnerable groups and aggravating the unfairness of the compensation system with excessive compensation for non-essential medical fields.” He added, “We will continuously monitor and respond to related cases.” “We will strengthen intelligence collection and crackdown on the issue,” he said.
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2024/10/28 12:00 Sent
