Hospital A, the largest oriental medicine hospital in Daegu, recently produced printed material advertising that it could provide "concussion diagnoses" and distributed it to insurance agencies and policyholders. A concussion diagnosis serves as a tool for minor-injury patients to collect insurance payouts after rules made long-term treatment beyond eight weeks harder to obtain. Hospital A encouraged admissions by promoting a "pickup service" and "free outings and overnight stays." One patient, surnamed Kim, who visited the hospital said, "They told me I could even stay out overnight, so I decided to be admitted for treatment."
According to financial industry sources on the 14th, a major South Korean non-life insurer that has gathered evidence of illegal insurance claims by Hospital A plans to file a criminal complaint against the hospital soon on suspicion of violating the Medical Service Act. Insurance payouts Hospital A collected from non-life insurers through August this year totaled 3.36 billion won, or 93% of the full-year amount paid last year.
The government introduced an "eight-week rule" to stop leakage of auto insurance payouts, but violations continue. Under the rule, patients with grade 12 to 14 minor injuries must undergo an appropriateness review to receive treatment beyond eight weeks after an accident. Concussion is classified as grade 11, placing it outside the rule.
Payout leakage is also severe in indemnity health insurance. In the first half of this year, nine non-life insurers paid 1.06 trillion won for non-reimbursable robotic surgery and injection treatments. An insurance industry official said, "Unless excessive treatment and high-cost non-reimbursable care are fundamentally managed, payout leakage and premium increases will inevitably continue." ▷Full story on Page 2
