Over 100 tips filed in 50 days at government's fake-treatment reporting center

Case No. 1: Hospital A fabricated inpatient records for patients who never actually stayed at the facility, filed private insurance claims on their behalf and refunded a portion of the legally required co-payments as kickbacks. Tips also alleged that the hospital provided patients with separate mobile phones to evade cell-tower location tracking. The conduct — falsifying medical records in violation of Article 22 of the Medical Service Act and deliberately deceiving insurers to collect payouts — constitutes insurance fraud.

Case No. 2: Tips alleged that the physician who nominally heads Hospital B received startup funding from a separate investor, who then took effective control of the hospital's operations and collected a fixed monthly payment in return. The arrangement falls under the so-called "office-director hospital" scheme, in which a non-medical person establishes a medical institution in violation of Article 33 of the Medical Service Act.

About 50 days after the government launched a reporting center for abnormal and fraudulent medical practices, tips have surpassed the 100 mark.

The Ministry of Health and Welfare said Tuesday that 102 reports of illegal or improper conduct had been filed with the center as of Friday. The center has been operating since June 15 alongside an administrative investigation unit targeting abnormal and fake medical practices.

Of the 102 cases, 27 involved false or improper billing, 26 involved illegal fee refunds (kickbacks), 26 involved patient solicitation or referral brokering, nine involved bundled non-covered treatment packages, and three were suspected office-director hospital cases.

By facility type, clinics accounted for the most reports at 26, followed by traditional Korean medicine hospitals at 23 and long-term care hospitals at 21. By region, Seoul led with 33 cases, followed by Gyeonggi Province and Incheon with 29, South Jeolla Province and Gwangju with 15, and Busan and South Gyeongsang Province with 10.

Reported cases will undergo big data pre-screening by the National Health Insurance Service and the Health Insurance Review and Assessment Service before on-site administrative inspections are carried out. Authorities will then refer cases for investigation to establish whether violations occurred.

The administrative investigation unit plans to protect the identities of tipsters to prevent a chilling effect on voluntary reporting, and will work closely with relevant agencies while taking into account the circumstances of each report and the level of cooperation provided.

Where a tip involves improper national health insurance billing or insurance fraud that qualifies for a reward under the relevant agency's whistleblower reward program, the unit said it will share the relevant materials to ensure the reward system functions smoothly.

Anyone may submit a tip, including healthcare workers, patients and their guardians. The more detail provided, the more useful it is for investigations — particularly the name of the medical institution, the tipster's relationship to it (such as a former employee, patient or family member), the date and location of the alleged misconduct, and supporting evidence such as consultation or call records, photographs, billing statements or financial transaction documents.

Kwak Sun-heon, head of the administrative investigation unit, said such conduct "is a serious violation that undermines the medical order and erodes public trust not only in people's lives and health but also in the national health insurance and private insurance systems." He added that all tips received would be carefully reviewed for credibility, thoroughly verified through analysis and on-site inspections by relevant agencies, and met with strict action in accordance with the law if violations are confirmed.