A patient received tens of millions of won worth of liver cancer treatment using another person's health insurance identity and repaid none of it, according to data released on the 25th. The patient died while living in the country without legal status, leaving the National Health Insurance Service with a loss of nearly 78.8 million won ($53,000).
105 Liver Cancer Treatments Under Another Person's Name
Data submitted by the National Health Insurance Service to Rep. Kim Sun-min of the Rebuilding Korea Party, a member of the National Assembly's Science, ICT, Broadcasting and Communications Committee, showed that a patient identified as A received liver cancer treatment at a tertiary general hospital from May 2020 to November 2023 using the health insurance identity of a man born in 1980, identified as B.
A received treatment under B's name 105 times in total. The fraudulent claims amounted to 78,785,460 won, the largest single case among those detected. The service recovered nothing after A died while in the country without legal status.
Another case involved long-term use of someone else's identity. A patient identified as C received insomnia treatment 65 times at clinic-level medical institutions from September 2012 to October 2022 under the name of a woman born in 1974, identified as D. That amounts to more than a decade of using another person's health insurance eligibility.
180,000 Fraudulent Claims, Less Than Half Recovered
Fraudulent claims from lending and misusing health insurance identities are widespread. From 2021 through the end of August this year, 184,443 cases were detected. The total amount determined to be fraudulently claimed reached 4.091 billion won.
By type, identity misuse without consent accounted for the vast majority, far outnumbering cases in which insurance cards were lent by mutual agreement. Identity misuse cases totaled 180,330, or 97.8% of the total, and accounted for 3.827 billion won in fraudulent claims.
The problem is that recovery falls far short of the scale of the fraudulent claims. Of the amount claimed through identity misuse, only 1.503 billion won was actually recovered. The uncollected amount stood at 2.324 billion won, leaving a collection rate of 39.27%.
Cases involving foreign nationals lending or misusing health insurance identities totaled 10,259 over the same period. Fraudulent claims from identity misuse in those cases amounted to 409 million won, with a recovery rate of 36.43%.
Recovery performance was weaker than for other categories. The collection rate was 60.83% for improper claims made after insurance eligibility had lapsed, and 82.75% for improper claims made during periods when benefits were suspended.