NHIS awards 469 million won in rewards to 18 informants for fraudulent claims

[Financial News]It was discovered through a report that A, a non-medical professional, conspired with B, a doctor, to operate an outcall medical examination center and share the examination fees. It was confirmed that A entered into a contract to pay B 30% of the examination fees received from the National Health Insurance Service (NHIS) in exchange for operating the outcall examinations, and they shared the profits. A reward of 176 million won will be paid to the person who reported this fact.The National Health Insurance Service (NHIS) announced on the 15th that it held the '2nd Health Insurance Reporting Reward Deliberation Committee of 2026' on the 10th and deliberated and decided on the payment of rewards to 12 medical institutions that falsely or improperly claimed medical benefits, 2 institutions that were illegally established, and 4 cases of fraudulent use of health insurance cards.
The total rewards to be paid to 18 informants following this review amount to 469 million won. The amount of illegal and improper claims confirmed by the reports reaches 6.22 billion won.
During the deliberation, cases of improper billing for nursing management fees were also confirmed. Hospital B reported nurses working in outpatient clinics and examination rooms who did not actually work in the wards as dedicated nursing staff, and billed for medical care benefits at Grade 3, which is higher than their actual grade. Through this, 395 million won was improperly received, and a reward of 45 million won was calculated for the whistleblower.
A case of fraudulent use of a health insurance card was also detected. Mr. A, unable to receive health insurance coverage due to unpaid premiums, used his older brother Mr. B's health insurance card to receive medical treatment. In this process, the medical benefit costs covered by the NHIS amounted to 45 million won, and a reward of 5 million won was awarded to the informant.
The NHIS has been operating a reward system for reporting health insurance violations since 2005 to prevent financial leakage in health insurance and eradicate illegal and fraudulent claims.
Kim Nam-hoon, Executive Director of Benefits at the NHIS, stated, "To eradicate increasingly sophisticated fraudulent and improper claims and the problem of 'manager-run hospitals,' continuous interest and prompt reporting from conscientious workers and righteous citizens are crucial," adding, "I ask for your active interest and participation in public interest reporting."
Meanwhile, starting December 23 of last year, the NHIS standardized the reward payment amounts that had been applied differently depending on the type of informant and raised the maximum reward payment limit to 3 billion won.
Reports of medical institutions making fraudulent claims can be made via the NHIS website and mobile app, by visiting a branch office, or by mail. The identity of the reporter is protected in accordance with the PUBLIC INTEREST WHISTLEBLOWER PROTECTION ACT.

[email protected] Jeong Sang-hee Reporter