Insurance fraud to cost South Korean government over US$500m

Most fraud cases remain undetected, making the actual figure much larger than what the data presents

Insurance News

By Gabriel Olano

Fraudulent and unfair health insurance claims will cost the government of South Korea around KRW600 billion (US$503 million) for 2016, according to data from the National Health Insurance Service (NHIS).
Health insurance fraud is still a serious problem, despite a government crackdown on scammers over the past few years, said the agency.
Data shows that false and unfair medical insurance claims reached KRW545 billion (US$452 million) from January to November of 2016, down from KRW594 (US$492) billion in the same period last year. This year’s level is on pace to reach KRW600 billion (US$503 million) by yearend, said the NHIS.
Naturally, the data only includes fraud cases that were detected. According to experts, most fraud cases go undetected, putting even more strain on the system, driving up premiums, and depriving legitimate cases of much-needed resources. The most popular scams include phantom treatments, double billing, and unneeded care.
In 2013, the Korea Institute for Health and Social Affairs estimated that health insurance fraud cost the government health insurer some KRW1.04 trillion (US$862.5 million).

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