Number of medical clinics caught for insurance fraud surges

When an oriental medical clinic in South Gyeongsang signed a contract with nearby day care centers and preschools last year, vowing to provide free checkups to young children, parents were elated.

They handed over their children’s personal information, thinking it was all for a good cause.

But what they didn’t know was that the “free services” were actually a fraudulent ploy for the clinic to gain insurance compensation from the government.

A police investigation later determined that the clinic had fabricated its patients’ medical records, reporting to the National Health Insurance (NHI) system 2,168 instances in which it had dispensed medical treatment to the young children. Through the scheme, it collected 24 million won ($24,647) worth of insurance compensation.

A parent whose child was examined by the clinic first alerted the police when she discovered that her child’s medical care statement contained false information.

But such practices aren’t uncommon in the medical industry, the NHI said. During the first half of this year, clinics participating in similar schemes drained more than 300 billion won, much more than the 214 billion won last year over the same period.

Data released by the NHI in July showed that the number of medical care institutions caught engaging in illegal activities was steadily rising: 2,522 cases were documented in 2013, a drastic increase from the 449 instances reported in 2009.

In 2010, 548 clinics were busted, surging up to 1,241 in 2011, and 1,239 in 2012.

However, the actual number of irregularities is likely to be much greater, the NHI told the press at that time.

In another example at a clinic in Daegu, 891 healthy patients in 2012 were diagnosed showing “other physical signs and symptoms.” For that, the institution received 11 million won worth of insurance compensation.

Similarly, in the same year, a Seoul clinic diagnosed 6,521 of its patients with “bowel syndrome of an unknown cause,” taking in 330 million won in insurance.

Some clinics also falsify the number of their doctors and nutritionists, including a nursing hospital in Incheon that illegally obtained 236 million won from the NHI.

“The NHI compensates medical institutions and then requests redemptions after a thorough investigation of those payments,” rather than the other way around, said Kim Jong-dae, director of the NHI.

Kim continued that some doctors take advantage of that procedure, and that the number of erroneous cases is sharply rising. “The system must be improved so that the NHI can detect corruption at the point medical institutions make insurance claims,” he said.

BY SHIN SUNG-SIK [selee@joongang.co.kr]