South Korean medical insurance fraud litigation

South Korean courts have issued rulings regarding the reclamation of funds and fraud charges related to National Health Insurance Service claims.

In one case, the Seoul Administrative Court upheld the reclamation of approximately 9 million won from a hospital for failing to follow mandatory COVID-19 home treatment monitoring protocols. The court rejected the hospital’s argument that twice-daily patient monitoring was not required for the entire duration of the service, stating that continuous health monitoring is the “essence of home treatment”.

In a separate matter, the Supreme Court overturned a lower court decision, finding that a hospital director committed fraud by concealing the involvement of a non-medical device worker during artificial hip replacement surgeries between 2015 and 2019. Although the doctor performed the primary surgical tasks, the court ruled that hiding the assistance of a non-medical worker to claim approximately 95 million won in insurance benefits constituted a deceptive act. The case has been remanded to the Seoul Central District Court.