허위입원을 통한 보험사기

Abstract

The aim of this paper is to analyze the reason that Korean specific medical insurance system augments insurance fraud and the legal theory which impose criminal responsibility to doctors and patients in false hospitalization cases. Korean dual medical insurance system positions private insurance into a supplementary role; public insurance precedes private one. The payments system that National Health Insurance Corporation pays a certain part of medical treatment fee to medical providers implicates them into insurance fraud. The structure of false hospitalization is very complicated, since patients can get benefit not only from National Health Insurance Corporation but also from private insurance company. Furthermore, court’s decision on whether doctors can be principal offender and whether complicity between patients and doctors can be presumed is not coherent. Since insurance fraud crimes are prevalent in Korea, more consideration on legal theories about insurance fraud should be established is needed.