Kathmandu. South Korea’s Ministry of Health and Welfare has announced a 3-month investigation from August to October. It targets medical institutions that are at high risk of fraud.
The scope of the investigation also includes suspicious hospitals operating as ‘manager hospitals’. They are effectively controlled by non-medical investors. Licensed doctors are used as nominal operators.
South Korea’s government will launch its first planned investigation in 3 years to prevent misuse of health insurance funds. The ministry said it has developed 198 case-specific assessment criteria for medical institutions that use fraud detection systems to calculate risk scores and health insurance review and evaluation services.
Facilities that were assessed as having a high probability of bogus claims were selected for the investigation. Medical institutions found to have submitted false claims will have to refund the unfairly claimed amount and face a fine under the National Health Insurance Act. These can include a business suspension of up to 1 year, a five-fold fine for fraudulent claims, public disclosure of their name, and suspension of their medical license.
According to the ministry, fraudulent billing, including claims for medical services that were never provided, caused an estimated $7 million in annual financial losses to the national health insurance system, Yonhap news agency reported.
