SEOUL, Dec. 21 (Korea Bizwire) – False health insurance claims in South Korea are expected to flirt with 600 billion won this year despite a crackdown on scammers, data showed Wednesday.
According to the data by the National Health Insurance Service, medical providers’ false and unfair insurance claims came to 545 billion won (US$456 million) in the first 11 months of this year, compared with 594 billion won in 2015. At the current pace, the amount for all of 2016 is widely expected to reach nearly 600 billion won.
Experts said the amount is just the tip of the iceberg because a large number of fraudulent and unfair health insurance claims go undetected. Health care scams include phantom treatments, double billing and unneeded care.
A report by the Korea Institute for Health and Social Affairs shows that false and improper health insurance claims cost the state health insurer 1.04 trillion won in 2013.
Local health care providers’ false and unfair claims are cited as a major drag on the coffers of the taxpayer-funded health insurance program, with lawmakers calling for more on-the-spot inquiries to counter fraud and manage the insurance fund more effectively.
Currently, the state service conducts on-the-spot inquiries into only 1 percent of all health care providers in the country.
As part of efforts to prevent money leaks, the state health insurer operates a reward program for informants and unveils the list of false claimants.