False claims for nursing care insurance increase 98-fold in 4 years... This year, the amount detected is expected to exceed the previous year’s amount.

(Seoul = Yonhap News) Reporter Park Soo-yoon = The practice of illegally receiving nursing care insurance paid to hospitalized patients who hire caregivers is rapidly increasing, People Power Party lawmaker Song Eon-seok, a member of the National Assembly's Political Affairs Committee, said on the 27th.

According to data on 'Status of detection of false claims for special contracts per day for hospitalization using caregivers' submitted by Rep. Song from the Financial Supervisory Service, the number of cases of false claims detected increased about 98 times in four years from 13 cases in 2021 to 1,278 cases in 2025. During the same period, the amount detected increased 229 times from 11 million won to 2.523 billion won.

As of July this year, 468 false claims worth 1.579 billion won were caught. If this trend continues until the end of the year, it is expected that the amount detected this year will also surpass the previous year's amount.

If you look at each case with a large cumulative disguised claim amount, there was a case where 50 million won was claimed for one caregiver.

However, Rep. Song pointed out that insurance companies cannot force caregivers to consent to the use of personal information because they are third parties to the insurance contract, so they do not separately collect personal information such as the caregiver's nationality.

Accordingly, concerns are raised that there are limitations in systematically analyzing abnormalities such as repeated claims by the same caregiver or cross-claims through multiple insurance companies.

Rep. Song said, "It is difficult to prevent systematic and repetitive false claims surrounding nursing care insurance if we only rely on post-detection detection by insurance companies," and ordered, "Financial authorities must quickly establish a joint verification system with the insurance industry that can objectively confirm whether nursing services are provided and actual payments while adhering to the principles of personal information protection, and detect repeated and cross-claims by the same caregiver at an early stage."

[Table] Status of detection of disguised claims for special contract per day of hospitalization using caregivers by year (unit: cases, 10,000 won)

Category 2021 2022 2023 2024 2025 2026 July Total number of cases detected 13 109 322 879 1,278 468 3069 Amount detected 1100 28500 44600 147,000 252,300 157,900 631,400 Average detection amount per case 84.6 261.5 138.5 167.2 197.4 337.4 205.7

※ Source: Song Eon-seok, People Power Party member of the National Assembly Political Affairs Committee, Financial Supervisory Service