The government is expanding its investigation into medical centers that falsely bill for Covid-19 treatment to the entire nation. The investigation will cover 8,423 medical institutions nationwide, from tertiary general hospitals to neighborhood clinics that treat Covid-19 patients.
The National Health Insurance Service submitted the “plan for expanded investigation based on the results of the sample survey on Covid-19 medical expenses" to the office of Rep. Jung Choun-sook of the Democratic Party, stating that it will expand the investigation into fraudulent claims for Covid-19 medical expenses from next month to next June.
Considering the lack of dedicated personnel for check visits, NHIS plans to combine computerized inspection, self-correction, and visiting checks.
First, the state insurer will conduct computerized inspections from October to December on target institutions related to billing separate medical fees for foreign travel on the day of vaccination and diagnostic tests. It will request clarification of evidence where abnormalities are found and retrieve money it had paid.
Patient management fees for home treatment will be self-corrected by nursing institutions. NHIS will provide checklists and guidance manuals for 922 surveyed institutions so that they can voluntarily report improper charges. The self-reporting period is until December.
The agency will visit and confirm those institutions that do not participate in self-correction, reply that the entire claim is justified, and are suspected of making false reports from December to June next year.
"We want to eradicate unjustified claims by confirming the proper expenditure of nursing care benefits through a nationwide survey, preventing financial leakage, and inducing proper billing by nursing care organizations," an NHIS official said.
The expanded survey is a follow-up to a sample survey conducted in October last year, which selected 12 of the top institutions for Covid-19 medical bills.
According to the agency, 950 million won ($708,000), or 9 percent of the total 10.4 billion won billed by the 12 institutions, were confirmed to be fraudulent.
Rep. Jung pointed out the problem of improper billing of Covid-19 medical expenses by some medical institutions, demanding an inspection of improper billing institutions in addition to the sample organizations.
There are three types of improper billing investigations:
● Billing for separate consultation fees on the day of Covid-19 vaccination
● Billing for patient management fees for home treatment
● Billing for separate tests after Covid-19 diagnostic tests for foreign travels
The nationwide probe will target 8,423 medical institutions -- 43 tertiary general hospitals, 257 general hospitals, 513 hospitals, and 7,610 clinics. The total amount charged by these medical institutions was 781.9 billion won, with home treatment patient management fees accounting for 97 percent of the total.
Of the 922 institutions identified for improper charging for home treatment, 483 were clinics, followed by 237 hospitals, 169 general hospitals, and six tertiary general hospitals.