2023-11-04 01:22:00
[이데일리 유은실 기자] ‘Fracture first, join later’ (Photo = Getty Image Bank) Mr. A, who fractured his ribs on January 16, 2017, has been busy since his injury. He visited En OO Orthopedics on the 16th and received treatment, and the next day, on the 17th, he signed up for insurance covering new fracture diagnosis fees from an insurance company. Also, on the 18th, he visited the △△ hospital and was diagnosed with a ‘rib fracture’ and submitted a medical certificate to the insurance company.
Mr. B signed up for a high-value fracture diagnosis insurance product on January 1, 2017. After suffering a fractured calf, he visited an orthopedic surgeon on the 16th, was diagnosed with a fibula fracture, and received treatment on the 18th. However, in fact, Mr. B was injured in 2016, the previous year.
In 2017, the scope of coverage for fracture diagnosis fees increased significantly. Many cases have been discovered where fractures that occurred before signing up for insurance were disguised as occurring following signing up for insurance. Insurance false claim fraud has spread like a trend, taking advantage of the fact that the fracture diagnosis fee, which was only 100,000 to 300,000 won in 2016, increased to 1 million won the following year.
Accordingly, a domestic insurance company conducted a large-scale on-site investigation of fracture diagnosis claims. After selecting some areas in Gyeonggi Province, we surveyed all subscribers who were diagnosed with fractures within 10 days of signing up for insurance. The period was set from January 2016 to January 2017. As a result of the investigation, 403 people were subject to investigation.
The police station compared the National Health Insurance Corporation’s salary details of the subjects of investigation requests with the data submitted by the insurance company. After comparing the data, it was revealed that 29 people confirmed their fracture diagnosis and subsequently signed up for insurance.
In this process, the involvement of a ‘designer’ was also captured. They organized a scheme with a planner and stole the fracture diagnosis money. The insurance money the insured and planners received for ‘fracture’ amounted to 400 million won. In the end, all 29 people who had been sent for indictment and 6 insurance planners involved in insurance fraud were sentenced to deferred prosecution and confirmed fines.
△The thermos metaphorically expresses warm insurance that breathes warmth into the world like a thermos while looking into all the sick places in society through insurance fraud.
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