Earticle

초록

영어

First introduced in 1977, Korean health care system reached to national coverage in short period of time never seen before in any other countries, and rated as successful system protecting the health of the public at relatively low price. However, despite those positive evaluations, some of fraudulent medical organizations or pharmacies are hindering the sound development of the national health care system with meticulous false billing exaggerating the number of patients or the days of their treatment. To prevent aforementioned nursing home fraud and false billing, the misconduct should be punished as subject to the criminal law and severally punished for fines and payments which far exceed the expected amount of illicit gains as it is basically violation of criminal fraud, other than the forced return of illicit gains based on civil laws. Furthermore, the Health Insurance Review and Assessment Service should strengthen and complement the fraud investigators, the review process, and the professional training to raise the detection rates. It might also want to review ways to implement whistleblower rewarding system and rewards for evidences of healthcare fraud to overcome the limits of external review.

목차

I. 서론
 II. 공보험범죄의 개념과 특성
  1. 공보험범죄의 개념
  2. 공보험범죄의 특성
 III. 부당ㆍ부정청구의 개념 및 유형
  1. 개념의 구별
  2. 부당청구의 개념
  3. 부정청구의 개념
 IV. 최근 사례
  1. 변호사 사무실 사무장, 병원 사무장 등이 관련된 보험사기사건
  2. 하지정맥류 전문병원, 17억 원대 보험금 편취사건
  3. 요양병원 대표 보험금 편취사건
  4. 일반환자의 의사가 결탁한 보험사기 사범 적발
  5. 사무장병원의 사무장, 의사, 브로커 및 허위입원환자가 연루된 조직적 보험사기사건
 IV. 결론
 참고문헌
 ABSTRACT

키워드

저자

• 허수진 [ Su Jin, Huh | 서울중앙지방검찰청 검사 ]

참고문헌

발행기관

간행물

표지보기 관심저널 등록

• 간행물명

  의료법학 [THE KOREAN SOCIETY OF LAW AND MEDICINE]

• 간기

  계간

• pISSN

  1229-8069

• 수록기간

  2000~2025

• 등재여부

  KCI 등재

• 십진분류

  KDC 517 DDC 613