Avoid hospitals that ask, “Do you have stop loss insurance?”

A hospital counseling staff suggested that customers could receive their desired plastic surgery and cosmetic procedures at a discount of 80 to 90 percent and file insurance claims by issuing documents as if they had undergone hydrotherapy. As a result, 25 people who received plastic surgery (nose, eyelids, etc.) and cosmetic procedures under the name of hydrotherapy were caught and fined 500,000 to 3.5 million won and had to return the insurance payments.

There has been an increase in the number of insurance frauds that falsely claim insurance benefits from insurers by pretending to have undergone hydrotherapy even though they are procedures such as plastic surgery, skin care, and nutritional injections안전놀이터. Financial authorities have urged people to be careful as they may be fooled by the word “free” and become involved in insurance fraud.

The Financial Supervisory Service issued a “caution” level consumer alert about the scam on Aug. 8. This is because insurance scams involving cosmetic and skin care procedures under the guise of veterinary treatment have increased in recent years. According to the Financial Supervisory Service, a total of 3096 patients were referred to investigations for such fraud from 2019 to last year. The number increased by 110% from 679 in 2019 to 1,429 in 2022.

The patients received cosmetic procedures that are not covered by medical insurance, but they submitted false medical receipts and medical certificates to insurers as if they had received hydrotherapy to treat pain. As this trend spread, the insurance industry intensified its investigations, and the number of detected cases increased.

Until now, insurers have focused their fraud investigations on high-value surgeries and diagnoses. This is because it was difficult to devote manpower and resources to hydrotherapy, which is a relatively small amount (on average, less than 2 million won). However, recently, insurance claims for hydrotherapy have increased dramatically, and some hospitals have detected that it is being done systematically. A professional organization consisting of an office manager, a counseling manager, an insurance agent, a hydrotherapist, and a beauty manager was formed and moved from hospital to hospital every two to three years, leading the insurance fraud. In response, insurers are strengthening their investigations and responses to insurance fraud.

The Financial Supervisory Service strongly urged people not to participate in such scams. It explains that you should be suspicious of any tempting offer that doesn’t make sense and firmly reject it. Keep in mind that insurance fraud will be detected, and actively report suspected cases of insurance fraud to the KFTC or insurance companies’ insurance fraud reporting centers. “Insurance fraud causes financial leakage of 6.2 trillion won ($6.2 billion) in private insurance and up to 1.2 trillion won in national health insurance annually,” said an official from the Financial Supervisory Service. “This damage is passed on to the general public through increased insurance premiums and adversely affects health insurance finances.”

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