The government will crack down on false claims that drain health insurance finances, such as fake patients and fake treatments. Health insurance special investigations, which were suspended for two years due to COVID-19, will also resume in the second half of this year.
According to the Ministry of Health and Welfare on the 4th, the government plans to conduct a special investigation in the second half of this year to uncover false health insurance claims. A special investigation is an on-site probe carried out in areas that need improvement or have raised social concerns during the operation of the health insurance system. It was suspended in 2024–2025 due to COVID-19, but a full-scale investigation could begin as early as Aug.
A false claim refers to billing health insurance as if care was provided when it was not. Typical cases include reporting that treatment was provided to a patient who did not actually receive it, or billing as if a physician who was not on duty had provided care.
According to the ministry, the annual average leakage from false claims amounts to about 9.6 billion won. This accounts for about 30% of the total amount of improper claims.
Major cases detected include inflating the number of inpatient days or visits, double billing after non-covered services, billing expense for tests, treatments, or medications not actually performed, inflating the number of medical acts, billing personnel expense for staff who did not actually work, and billing for...
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