South Korean Supreme Court rules doctor committed fraud by hiding medical device worker's involvement in surgeries

The Supreme Court of South Korea has overturned a lower court ruling, finding that a doctor committed fraud by concealing the participation of a non-medical medical device worker during surgeries to claim National Health Insurance benefits.

Between 2015 and 2019, a hospital director (A) performed 32 artificial hip replacement surgeries with the assistance of a medical device supplier (B). While the doctor performed the primary surgical tasks, the non-medical worker assisted by using a medical drill to create space and positioning surgical tools. The doctor then claimed approximately 95 million won in medical expenses from the National Health Insurance Service, representing the procedures as if they had been performed solely by a licensed medical professional.

While a second instance court had previously acquitted the doctor of fraud—arguing that the doctor still performed the main surgical actions—the Supreme Court ruled that this was a legal error. The court emphasized that hospitals are only entitled to claim insurance benefits for lawful medical acts conducted in accordance with the Medical Service Act. By hiding the involvement of a non-medical person, the doctor misled the insurance service, which constitutes a deceptive act under fraud laws. The case has been remanded to the Seoul Central District Court.