The amount of cases involving forged or altered medical certificates and inflated hospitalization and surgery costs reached 147.3 billion won in the first half of this year, a sharp increase of 37.2% compared to the same period last year. As manipulation of accident details increased, the total amount of detected insurance fraud rose to 620 billion won, the highest figure for the first half of any year in the past five years.
The Financial Supervisory Service announced on the 28th that it detected 620 billion won in insurance fraud and apprehended 53,865 individuals in the first half of this year.
Compared to the same period last year, the detected amount increased by 51.8 billion won (9.1%), and the number of apprehended individuals rose by 2,849 (5.6%). By fraud type, cases involving manipulation of accident details, such as overclaiming insurance benefits, accounted for 379.8 billion won, or 61.3% of the total, an increase of 54 billion won (16.6%) from the same period last year.
In particular, detected cases of forged medical certificates and excessive claims for hospitalization and surgery costs rose by 39.9 billion won (37.2%), from 107.4 billion won in the first half of last year to 147.3 billion won this year. Cases involving manipulation of drivers, damaged property, or accident dates in car accidents, or exaggeration of damages, also increased by 18.5 billion won (17.3%), from 106.8 billion won to 125.3 billion won.
Detected amounts for fabricated accidents, including cases where illnesses were disguised as injury accidents or individuals were made to appear falsely missing to claim insurance benefits, totaled 108.1 billion won, a decrease of 8.2% from the same period last year. Conversely, detected amounts for intentional accidents such as deliberate collisions, suicide, and self-harm rose by 31.5% to 86.4 billion won.
By insurance type, car insurance accounted for the largest share at 288 billion won (46.5%). Long-term insurance, including medical reimbursement insurance, totaled 264.5 billion won (42.7%). The detected amount for long-term insurance increased by 34.3 billion won (14.9%) compared to the first half of last year, representing the largest increase among all categories.
By age group, individuals in their 60s accounted for the largest share at 13,247 people (24.6%), an increase of 3,191 (31.7%) from the same period last year. This was followed by those in their 50s with 12,259 individuals, those in their 40s with 9,619, and those in their 30s with 8,399.
By occupation, company employees were the most numerous at 14,656 people (27.2%). They were followed by full-time homemakers with 5,855 individuals, unemployed or daily workers with 4,942, and vehicle transportation industry workers with 2,246.
The FSS plans to expand cooperation with the National Police Agency, Ministry of Health and Welfare, National Health Insurance Service, and Health Insurance Review & Assessment Service to combat hospital-led insurance fraud. It decided to activate a fast-track system that collaborates with police from the investigation stage at the Financial Supervisory Service (FSS) to increase the rate of initiating investigations and reduce the time required for referral requests.
An amendment to the Insurance Business Act, which mandates the swift expulsion of insurance agents convicted of insurance fraud, will take effect in March next year. The FSS intends to cancel the registration of insurance agents who have been convicted of insurance fraud.
The special reporting and reward period for insurance fraud will continue until the end of next month. Individuals or institutions suspected of committing medical reimbursement or car insurance fraud, such as hospitals, clinics, doctors, and auto repair shops, can be reported with specific physical evidence. Those who actively cooperate in ongoing investigations will receive rewards ranging from 10 million won to 50 million won from the Life & Non-Life Insurance Association.
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