FSS, insurance associations to launch fraud prevention training for nursing aides from first quarter of next year

Falsifying medical records punishable by up to 10 years in prison

[Getty Images Bank]
[Getty Images Bank]

A, a nursing aide at a long-term care hospital, repeatedly received the same request from a hospitalized patient: write "caregiver in constant attendance" on the nursing record so the patient could file a caregiver insurance claim. In fact, no caregiver was present. After refusing multiple times, A ultimately filled out the record falsely — and in doing so, became potentially liable for insurance fraud.

Financial regulators are now stepping in with prevention training to stop nursing aides from unwittingly becoming accomplices to insurance fraud by accommodating patients' requests.

The Financial Supervisory Service said Monday it will launch insurance fraud prevention training for nursing aides starting in the first quarter of next year, in partnership with the Korea Life Insurance Association, the General Insurance Association of Korea, and the Korean Association of Nurses Aides.

The FSS identified three common scenarios in which nursing aides risk being drawn into insurance fraud: recording "caregiver in constant attendance" on nursing charts at a patient's request when no caregiver was actually present; exaggerating symptoms in medical records at the request of patients or their families who want hospitalization despite being eligible for outpatient care; and logging examinations, procedures, or treatments that were never performed, or inflating the number of times they were carried out.

Such conduct can be prosecuted under the Act on Special Cases Concerning the Prevention of Insurance Fraud. The law defines insurance fraud as deceiving an insurer about the occurrence, cause, or details of an insured event in order to claim benefits. Anyone who causes themselves or a third party to receive insurance proceeds through fraud — or who arranges, induces, or solicits such fraud — faces up to 10 years in prison or a fine of up to 50 million won ($37,800).

The FSS said the need for protection had long been raised because nursing aide training programs had not adequately covered the concept of insurance fraud or the scenarios in which aides could inadvertently become involved at medical facilities.

Nursing aides face heightened exposure to insurance fraud given their frontline role in healthcare settings. According to national health insurance statistics, 223,988 nursing aides were employed at medical institutions as of the second quarter of this year. Of those, 168,340 — or 75.2 percent of the total — worked at clinics (138,861) and long-term care hospitals (29,479).

The training will focus on major types of insurance fraud, specific case examples, and how to respond. It will also cover the definition of insurance fraud and the penalties involved. Given that nursing aides are often the first to notice suspicious behavior, the program will include instruction on how to report suspected fraud.

Training will begin online to maximize accessibility, with plans to expand to in-person sessions depending on participation rates and effectiveness.

"We hope this will not only protect nursing aides from being implicated in insurance fraud, but also help drive fraud out of medical settings entirely — ultimately strengthening public trust," an FSS official said.


won@heraldcorp.com